Evaluation of factors influencing morbidity and mortality in cases of oesophageal atresia and/or tracheo-oesophageal fistula repair

Presented by: Rajan Kumar

AIMS AND OBJECTIVES
• Evaluate the factors influencing morbidity and mortality in cases of OA with or without TOF repair. • Know the Preoperative,Intraoperative and Postoperative causes responsible for poor outcome of operation. • This study can help us to improve outcome in OA with or without TOF cases in future.

STUDY DESIGN
• No. of cases:• Duration of study:• 30 • July 2006 to September 2008

• Preparation of patients
Patients should be prepared for surgery with stabilization of vitals , infection and correction of sugar or electrolyte abnormalities.

OBSERVATION
Distribution of cases according to
S. No Sex No of patients

Sex

No of Survivals

No

%

No

%

1 2

Male Female Total

15 15 30

50 50 100

3 5 8

20 34

1 Male 2 Female

Birth Weight (Kg)
S. No Birth weight (Kg) No of patients No % No of Survivals No %

1

1.5 to 2.0

18

60

5

28

2
3

2.0 to 2.5
>2.5 Total

7
5 30

23
17 100

2
1 8

29
20

Distribution of cases according to Age group (hours)
S. No Time (hours) No No of patients % No of Survivals No %

1

<24

7

23

2

29

2 3

24-48 >48
Total

8 15
30

27 50
100

4 2
8

50 13

Distribution of cases according to Gestational age
S. No GA No of patients No of Survivals

No

%

No

%

1

Full term

25

83

8

32

2

Preterm
Total

5
30

17
100

0
8

0

Associated congenital anomalies (27%)
S. No Associated anomalies No of patients No % No of Survivals No %

1 2 3 4 5 6 7

Anorectal malformation
Cardiac anomaly Other gastrointestinal anomalies Renal anomalies

4 3 1 2 4 1 2

13.3
10 3 6

0 0 0 0 0 0 0

0 0 0 0 0 0 0

VACTERL anomalies
Hypospadias (Penoscrotal) Right sided aortic arch

13.3
3 6

Pneumonia (Clinical and Radiological) at presentation
S. No Pneumonia No of patients No % No of Survivals No %

1 2

Present
Absent Total

19
11 30

63
37 100

0
8 8

0
73

Sepsis at presentation
S. No Sepsis No No of patients % No of Survivals No %

1 2

Present
Absent Total

8
22 30

27
73 100

0
8 8

0
36

Type of OA / TOF
S. No Type No of patients No % No of Survivals No %

1 2 3

III b/C II / A Oeseophageal web Total

20 3 1 30

83
13 3 100

5 3 0 8

25 100 0

Gap between proximal and distal oesophageal segments
S. No GAP No of patients No of Survivals

No

%

No

%

1 2

Long Short Total

9 15 24

37 63 100

4 4 8

44 27

Post operative sepsis
S. No Post operative sepsis No of patients No of Survivals

No

%

No

%

1 2

Present

16

67

0

0

Absent
Total

8
24

33
100

8
8

100

Main cause of death
S. No Cause of Death No of patients No of Survivals

No

%

No

%

1

Sepsis Total

21 21

100 100

0 0

0 0

Cause of sepsis
S. No Cause of sepsis No of patients No % No of Survivals No %

1 2

Pneumonia Anastomotic leak Total

16 05 21

76 24 100

0 0 0

0 0

After applying Waterston criteria results are
S.No. Group No of patients No Survival %

1
2 3

Group – A
Group – B Group – C
Total

6
15 09
30

6
2 00
08

100
16 00

Overall result in total no. of patients

3 27

70

Survival

Death

LAMA

Overall result in total No of operated patients

34

66

Survival

Death

The factors which lead to high morbidity and mortality are
• • • • • Sepsis at time of presentation or acquired during hospitalisation. Pneumonitis at presentation or acquired during hospitalization. Associated congenital anomalies Long gap in between the proximal and distal oesophageal segments Anastomotic leaks.

• • • • •

Low birth weight Delayed diagnosis Delayed referrel. Low socioeconomic status Lack of advanced neonatological backup

INFERENCE
• • • • • • • Promotion of trained labour Newborn examination Early diagnosis Prompt referrel Proper newborn care Appropriate operation Neonatal icu care

• With the joint effort of the persons starting from PHC level to TERTIARY level the outcome of oesophageal atresia and/or tracheo-esophageal fistula will improve.

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