Is tracheomalacia a postoperative complication of Oesophageal Atresia with Tracheo-oesophageal Fistula ?

Abstract

Postoperatively survived 24 oesophageal atresia (EA) with tracheo-oesophageal fistula (TEF) infants were studied. Development of postoperative tracheomalacia (TM) is whether due to anomaly of tracheal structure or by surgical manipulation is not yet known well. We analyzed these factors in our infants. The onset of TM and tracheal structural anomalies in relation with sex, types of EA, TEF communicating level and gap between two oesophageal ends were analyzed. Surgical procedures during primary radical operation were evaluated according to the division of azygos vein or without it. A total of 11 infants developed postoperative TM within 98 + 88 days; 38% postoperative EA with TEF infants developed TM; only 14% of them had severe symptoms and needed aortopexy. Post-aortopexy (83%) improved well and are comfortable, for more than 33.8 + 35.3 months. However, mild to moderate symptomatic infants, managed conservatively, also improved and are asymptomatic for 88 + 46 months in the recent follow-up.

Male predominance was observed significant (p = 0.004) for the development of postoperative TM. Those who developed postoperative TM had only Gross C type of EA. Statistically Gross C type of EA showed significant relation (p = 0.02) with postoperative TM, whereas other types of EA could not show significant relation between them. However, statistical relationship with postoperative TM between TEF communicating level, gap between two oesophageal ends and division of azygos vein or without it, could not show significant differences. These findings suggested that sex of infants and type of EA play a significant role, and surgical procedure has only relative association to develop postoperative TM in EA with TEF corrected infants.