A more than 25-year experience with end-to-end versus end-to-side repair for esophageal atresia

Abstract

End-to-end anastomosis has become the standard technique for repair of esophageal atresia with distal tracheoesophageal fistula. End-to-side anastomosis with ligation of the fistula in continuity has also been advocated. For over 25 years both methods have been used in this hospital. The purpose of this report is to compare retrospectively the results obtained with these two techniques. Between 1962 and 1988, 111 neonates underwent repair of esophageal atresia and distal tracheoesophageal fistula. 74 patients had an end-to-end repair and 37 had end-to-side anastomosis with fistula ligation, according to the surgeons' preference. There were no significant differences between the two groups with respect to preoperative variables and Waterston classification. There was a significantly increased incidence of fistula recanalization (22% v 3%, P = .003) and mortality directly related to the esophageal atresia (16% v 3%, P = .03) in the end-to-side group versus the end-to-end group. The end-to-end group had a significantly higher incidence of gastroesophageal reflux. Logistic regression analysis showed that the end-to-side repair was associated with a greater overall mortality. We conclude that the end-to-end repair appears to be a safer procedure than the end-to-side technique.