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Observational Study
. 2020 Jul-Dec;17(3 & 4):99-103.
doi: 10.4103/ajps.AJPS_72_19.

Thirteen ribs and long gap oesophageal atresia: The embryological hypothesis for exploration

Ramesh B Hatti  1 , Anita H Nyamagoudar  1 , Timman Gouda R Patil  1 , Sunil J Patil  1 , Rajendra T Patil  1 , Praveen R Pylla  1
Affiliations
Observational Study

Thirteen ribs and long gap oesophageal atresia: The embryological hypothesis for exploration

Ramesh B Hatti et al. Afr J Paediatr Surg. 2020 Jul-Dec.

Abstract

Context: Since the gap between two atretic segments of oesophagus is a critical determinant of prognosis for oesophageal atresia/tracheoesophageal fistula (EA/TEF), the search for a surrogate non-invasive pre-operative marker of long gap atresia continues.

Aims: The purpose of the study was to compare the presence of normal and supernumerary ribs with length of EA and survival rates.

Settings and design: A prospective observational study was conducted at a tertiary care referral neonatal intensive care unit in North Karnataka, India, from January 2016 to June 2019.

Subjects and methods: Amongst babies with EA/TEF, pre-operative radiograph helped determine the number of ribs, and babies were divided into two groups; Group I: babies with 12 ribs and Group II: babies with supernumerary ribs.

Statistical analysis used: Nominal variables were expressed as percentage and continuous variables as mean standard deviation. MedCalc software was used to compare proportions and means. A P < 0.05 was considered statistically significant.

Results: Of the 61 cases, 51 were operated. Long gap EA was predominantly seen amongst babies in Group II (40% in Group II vs. 27% in Group I, P= 0.424). Survival rates by percentage were lower in babies in Group II (60% in Group II vs. 80% in Group I, P= 0.188). Both the above findings were proven statistically insignificant. The overall survival rate amongst the study population was 78.4% (39/51).

Conclusions: Supernumerary ribs were associated with a higher occurrence of long gap EA and lower survival rates, though statistically insignificant. Multicentre collaboration may provide significant input for strengthening or refuting the above hypothesis.

Keywords: Fistula; long gap oesophageal atresia; supernumerary ribs; thirteen ribs; tracheoesophageal.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Chest radiograph showing 13 ribs and oesophageal atresia
Figure 2
Figure 2
Intra-operative picture showing mild gap oesophageal atresia in the same baby with 13 ribs. a – atretic segment of oesophagus, b – fistula tract
Flow Chart 1
Flow Chart 1
Flow chart depicting distribution of study subjects based on number of ribs (DAMA: Discharge against medical advice)
See this image and copyright information in PMC

References

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