Risk factors for short- and long-term morbidity in children with esophageal atresia.

OBJECTIVE: To describe short- (first year of age) and long-term (after 1 year of age) outcome in patients with esophageal atresia and identify early predictive factors of morbidity in the first month of life. STUDY DESIGN: Charts of children with esophageal atresia born January 1990 to May 2005 were reviewed. A complicated evolution was defined as the occurrence of at least 1 complication: severe gastroesophageal reflux, esophageal stricture requiring dilatations, recurrent fistula needing surgery, need for gavage feeding for >or=3 months, severe tracheomalacia, chronic respiratory disease, and death. RESULTS: A total of 134 patients were included. Forty-nine percent of patients had a complicated evolution before 1 year of age, and 54% had a complicated evolution after 1 year. With bivariate analysis, predictive variables of a complicated evolution were demonstrated, including twin birth, preoperative tracheal intubation, birth weight <2500 g, long gap atresia, anastomotic leak, postoperative tracheal intubation >or=5 days, and inability to be fed orally by the end of the first month. After 1 year of age, the complicated evolution was only associated with long gap atresia and inability to be fed orally in the first month. A hospital stay >or=30 days was associated with a risk of a complicated evolution at 1 year and after 1 year of age (odds ratio, 9.3 [95% CI, 4.1-20.8] and 3.5 [95% CI, 1.6-7.6], respectively). CONCLUSION: Early factors are predictive of morbidity in children with esophageal atresia.

Tubo en T de Montgomery. Indicaciones y técnica / Montgomery T-tube. Indications and technique

La resección con anastomosis término terminal de tráquea y cartílago cricoides es el tratamiento de elección para pacientes con estenosis traqueal o laringotraqueal. Sin embargo, un grupo de enfermos necesitarán otras opciones a causa de condiciones locales y/o generales de éstos, entre ellas la colocación de un tubo en T de Montgomery. Los objetivos del trabajo fueron establecer las indicaciones del uso del tubo en T y describir los detalles de la técnica quirúrgica empleada.. Se estudiaron 52 pacientes tratados por estenosis laringotraqueal o traqueal no tumoral, desde 1984 hasta el 2002. Las principales indicaciones para la inserción del tubo fueron: estenosis extensa, resección traqueal previa y estenosis doble, todas ellas con el denominador común de una probable tensión excesiva sobre la línea de sutura. Además de estenosis subglótica y glótica, localización baja de la estenosis, posible falta de cooperación por el enfermo en el posoperatorio inmediato y traqueomalacia entre otras. Se describen las maniobras quirúrgicas para la colocación del tubo en T. El tubo en T de Montgomery es una alternativa a la resección y anastomosis término terminal de tráquea y laringe en enfermos en los que se sospeche tensión excesiva sobre la línea de sutura, en estenosis de localizaciones particulares como las glóticas y subglóticas, y en quienes se espera poca cooperación posoperatoria por problemas neurológicos o psiquiátricos o cuando se necesitara una operación de gran envergadura y alto riesgo.

Resection with termino-terminal anastomosis of trachea and cricoid cartilage is the treatment of choice for patients with tracheal or laryngotracheal stenosis. However, a group of patients will require other options due their local and/or general conditions,such as Montgomery T-tube. The objectives of this paper is to set the indications for the use of T-tube and to describe the details of the surgical technique used. Fifty two patients with non-tumoral laryngotracheal or tracheal stenosis were studied from 1984 to 2002.the main indications for the placement of T-tube were: extensive stenosis, previous tracheal resection and double stenosis, all of them probably exerting an excessive pressure on the suture line in addition to subglotic and glotic stenosis, low location of stenosis, possible lack of cooperation on the part of the patient in the inmediate postoperative period and tracheomalacia, among others. Also, the paper describes surgical maneuvers to place T-tube. Montgomery T-tube is an alternative to resection and termino-terminal anastomosis of trachea and larynx in patients who are suspected to have excessive pressure on the suture line, in stenosis of particular locations like glotic and subglotic locations and in patients who are expected to be less cooperative in the postoperative period because of their neurological or psychiatric problems or whenever a major highly risky surgery is needed(AU)