MANAGEMENT AND PROGNOSTIC FACTORS OF ESOPHAGEAL ATRESIAIN UNDER-EQUIPPED FACILITIES: ABOUT 93 CASES

Introduction: Mortality inesophageal atresia remains high in sub-Saharan Africa. Our purpose in this study is to describe our diagnostic and therapeutic management, and also identify the factors of morbidity and mortality in ill-equipped environment. Patients And Methods: A retrospective descriptive and analytical study was carried out between April 2010 and March 2016 on newborn cases in the Department of Pediatric Surgery at the Albert Royer Children's Hospital in Dakar, for esophagealatresia. The parameters studied were as follows: delay in diagnosis, the associated pathologies, if any, Waterston's system of prognostic classification, the surgical time, and the clinical and paraclinical evolution after treatment. Outcomes: Ninety-three cases of esophageal atresia have beentreatedfor the last six years. There were 59 boys and 34 girls. No cases of prenatal diagnosis were noted. Excessive salivation and respiratory distress were mainly thebackground circumstances. The mean age at admission was 5.16 days (ranging from 0 to 21 days). The mean therapeutic time was 8.41 days with extremes of 1 and 21 days. The related disorders were cardiac in 58.33% of cases, anorectal in 25% of cases, digestive and bony in 16% of cases. Applyingthe Waterston classification, 38 patients were in Group A, 45 in Group B, and 10 in Group C. Hospital-acquired infection (HAI) and anastomotic fistula constituted the bulk of postoperative morbidity. Sixty-one patients died after surgery, an overall mortality rate of 76.3%. Sixty-five percent of them had a nosocomial infection. Mortality was 73.49% after surgical operation with a survival rate of 26.51%. Conclusion: Mortality in esophageal atresia is still high in developing countries and remains mainly related to delayed diagnosis, associated malformations and nosocomial infections.