Esophageal atresia: Historical evolution of management and results in 371 patients

Background. It has been more than 50 years since the first successful surgical reconstruction of esophageal atresia was performed in The Netherlands. We reviewed the historical changes in management and treatment results of patients born with esophageal atresia. Methods. We developed and analyzed a database of 371 consecutive patients treated for esophageal atresia in our center between 1947 and 2000. Results. The mean birthweight decreased from 2,723 g (1947 to 1968) to 2,494 g (1994 to 2000), the mean gestational age decreased from 39 weeks (1947 to 1968) to 37 weeks (1994 to 2000). The number of patients with associated congenital malformations increased from 34% (1947 to 1968) to 66% (1994 to 2000). Most patients underwent primary repair of their atresia. Clinically significant tracheomalacia was present in 34 of 269 patients (13%). Gastroesophageal reflux was present in 90 of 277 patients (33%). Mortality decreased from 61% (1947 to 1968) to 11% (1994 to 2000). Conclusions. The patients who are treated nowadays for esophageal atresia in a pediatric surgical center are born earlier, weigh less, and have more associated anomalies than those treated 50 years ago. Still, the mortality rate is much lower thanks to earlier diagnosis, better supportive care and improved surgical techniques. Therefore, further significant reduction will be difficult to achieve. (C) 2002 by The Society of Thoracic Surgeons.