Atresia esofágica: Evaluación, manejo y seguimiento de 18 casos.

Abstract

Esophageal atresia: management, follow up and evaluation of 18 cases We studied retrospectively 18 cases of esophageal atresia at a university associated metropolitan hospital of Santiago, Chile. Fifteen patients were operated and followed up a'ong an average 14 months. Survival rate cr all operated cases was 73.33%. while it was 100% for patients w : th Waters-ton type A operative risk, 63.3% for those with Waterston type B 1 risk and bO% for patients w;th Waterston C2 risk type. In 63.6% patients tnere were mayor associated anomalies. Routine gastronomy was not necessary when a primary anastomosis was cone. Primary anastomosis in one laye', with 6/0 Vycril®, without movilization cr the distal esophagus, proved to be excellent in the prevention of esophageal structure. There was only one case of temporal filtration through the suture site which solved spontaneously. Vigourous antire~flux treatment was used from the moment of diagnosis, it also in-cluded the ^se of cimetidene to prevent esophagitis from preoperative throughout postoperative periods. There were few surgica^ complications and no mortality due to them. There was an unusual case of a double f'Stula, ;n which the proximal one was very high at the neck and was missed in the initial thoracotorry. (Key words: esophsgeal atresia, tracheoesophageal fistula.). La atresia esofagica es una malformacion in-compatible con la vida, Antes de 1931 era fatal. En 1941 el Dr. Cameron Haight, de Michigan, efectuo la primera correccion exitosa realizando una anastomosis primaria del esofago interrum-pido. Inicialmente los resultados globales de sobrevida fueron pobres, lo que derivaba de diagnosticos tardios, que ocasionaban neumo-ni'as qui'micas fatales. Desde ese momento los resultados han mejorado progrcsivamente y hoy la sobrevida esta cerca del 100%, si no hay fac-torcs de mal pronostico. Ellos son: prematurez, bajo peso de nacimiento, presencia de neumo-patfa preoperatoria y malformaciones asociadas. Con el diagnostico precoz en base a una sospe-cha cli'nica en los enfermos que presentaban po-lihidroamnios y el paso de rutina de una sonda al estomago en todos los recien nacidos, se ha logrado minimizar la neumonfa preoperatoria. Las mejoras en la tecnica quirurgica, elemen-tos de sutura mas finos, que causan menor