Aim of the study
Conservative management of gastrooesophageal reflux (GORD) in oesophageal atresia
(OA) is sometimes inefficient, and fundoplication is required. We assessed the outcomes
of fundoplication among OA patients from 1980 to 2016.
After ethical consent, hospital records of 290 patients, including 22 referred patients,
were reviewed. Included were 262 patients with end–to–end repair. Excluded were patients
who underwent oesophageal reconstruction (n = 23) or no repair (n = 5). Primary outcome measures included survival, retaining the native oesophagus, resolution
of GGORD symptoms, failure of fundoplication, and long-term endoscopic results.
Gross types of OA in 262 patients were A (n = 12), B (n = 2), C (n = 217), D (n = 10), E (n = 19), and F (n = 2). Eighty-six (33%) patients, type A (n = 12, 100%), B (n = 2, 100%), C (n = 69, 31%), D (n = 3, 30%), and F (n = 1, 50%), underwent fundoplication at the median age of 5.4 (IQR 3.1–16) months. Main
indications included recalcitrant anastomotic stenosis (RAS) in 41 (48%), respiratory
symptoms in 16 (19%), and acute life threatening events (ALTE) in 15 (17%) of patients.
Associated tracheomalacia in 25 (29%) patients were treated with aortopexy. Median
follow–up was 7.5 (IQR 1.8–15) years. RAS resolved in 30 (73%) patients, whereas 11
(27%) with unresolved RAS underwent oesophageal resection (n = 8) or replacement (n = 3). Six (7%) patients died of heart failure (n = 4), bolus impaction (n = 1), and ALTE (n = 1). Fundoplication failed in 27 (31%) patients, and 13 (15%) underwent redo fundoplication.
Fundoplication failure was predicted by long-gap OA RR = 3.8 (95%CI = 1.1–13), P = 0.04. In total GORD associated symptoms persisted in 7 (8%) patients, including one
with permanent feeding jejunostomy. Latest endoscopy showed moderate or severe oesophagitis
in 7% of fundoplicated and in 3% nonfundoplicated patients and intestinal metaplasia
in 3% and 1% (p = 0.20–0.29).
Fundoplication provided a safe and relatively effective control of OA associated symptomatic
GORD and oesophagitis. The failure rate of fundoplication was high in those with long-gap
Type of study
Level of evidence