Evaluation of Pulmonary Complications and Affecting Factors in Children
for Repaired Esophageal Atresia and Tracheoesophageal Fistula
Abstract
INTRODUCTION: Recurrent pulmonary infections, wheezing and stridor due
to swallowing dysfunction, esophageal dysmotility, gastroesophageal
reflux, tracheomalacia and bronchomalacia are frequently seen
complications after esophageal atresia and tracheo-oesophageal fistula
(EA-TEF) surgeries. This study aimed to investigate the frequency and
causes of respiratory problems and to evaluate the factors that affect
respiratory morbidity in patients who had undergone EA-TEF repair in a
tertiary referral center. METHODS: Preoperative and postoperative
records of patients with EA, TEF+EA and isolated EA were examined
retrospectively. Accompanied diseases and swallowing dysfunction
symptoms were questioned. Bronchoalveolar lavage results were
investigated if the patient had flexible bronchoscopy. RESULTS: A total
of 71 children with EA were included in the study, and seven patients
who did not have follow-up after surgery were excluded. 46 of the 64
patients continue regular follow-up visits in our department. Male sex,
primary EA repair in another center, EA type C, accompanying genetic
anomalies, severe tracheomalacia, late per oral feeding (1 year after
surgery), and severe GER were found to cause significantly higher
incidence of coughing, recurrent wheezing, recurrent pneumonia, and
bronchiectasis despite surgical and medical treatments (p = 0.048, p =
0.045, p = 0.009, p = 0.029, p = 0.025) CONCLUSİON: Even if anatomical
anomalies are corrected by surgery in patients who underwent EA repair,
precautions can be taken for GERD, laryngotracheomalacia, and swallowing
dysfunction, and effective pulmonary rehabilitation can be initiated
with early multidisciplinary approach before the development of
respiratory tract symptoms.