K. Duru1, S. Twardus1, E. Ntaganda3, C. Moneme2, M. Fleming2, J. Habumufasha3, A. Kanyamuhunga3, T. Kelly4, S. Kabagambe2,5 1University of Virginia, School Of Medicine, Charlottesville, VA, USA 2University of Virginia, Department Of Surgery, Charlottesville, VA, USA 3Centre Hospitalier Universitaire de Kigali (CHUK), Department Of Surgery, Kigali, Rwanda 4University of Virginia, School Of Nursing, Charlottesville, VA, USA 5University of Virginia Children’s Hospital, Charlottesville, VA, USA
Introduction: Esophageal atresia (EA) with or without tracheoesophageal fistula (TEF) is a rare congenital disorder resulting from the failure of the laryngotracheal tube to separate during the early stages of fetal development with a significant risk of morbidity and mortality. With advances in prenatal care, surgical techniques, and an increase in pediatric surgeons, mortality rates of infants with EA+/-TEF have steadily declined in high-income countries. Comparatively, mortality rates remain as high as 80% in low- or middle-income countries (LMICs). Furthermore, studies evaluating the management of this condition in these resource-limited settings are limited. We provide an analysis of the existing landscape for infants with EA+/-TEF at a high-volume tertiary care center in Rwanda, subsequent to the introduction of specialized care offered by fellowship-trained pediatric surgeons.
Methods: A descriptive retrospective cohort study of infants evaluated for esophageal atresia and tracheoesophageal fistula from 2015 – 2023 at a tertiary center in Rwanda was conducted. Patients were identified from surgical logbooks based on the documented diagnosis of esophageal atresia and/or tracheoesophageal fistula. All patients with confirmed diagnoses were eligible for this study. 84 patients were identified from the logbooks. Patient age, sex, socio-demographic patient factors, EA+/-TEF classification, comorbid conditions, operative approach, and postoperative outcomes data were collected. Data analysis was conducted using SAS Software and results are reported at mean ± SD.
Results: Patient records of 56 patients with the diagnosis of EA+/-TEF were readily available from medical records. 98.1% of the infant’s mothers had a prenatal visit and 66.7% had at least one prenatal scan. All infants were born at term and on average arrived within 7 days of birth (6.98±5.18). EA with distal TEF (type C) was the most common type of anomaly identified (68.9%) and pure EA (type A) was found in 12.5% of this cohort. On average, infants were 11.48 ± 6.33 days old and weighed on average 2401.6 ± 648.9 grams at the time of EA/TEF repair. An extrapleural approach was used in the definitive repair for 62.5% of the neonates. All of the patients were operated on by a fellowship-trained pediatric surgeon. Mortality data was only available for 46/56 patients. Of this subset, the 30-day postoperative mortality was 52.17%.
Conclusion: In conclusion, our study provides insights into the landscape of infants with EA+/-TEF at a Rwandan tertiary care center post the introduction of specialized care. Given the advancements in prenatal care, pediatric surgical training, and critical care the mortality in this cohort is less than in other low- or middle-income countries. Our study's next goal is to ascertain patient and clinical factors that correlate with successful EA+/-TEF repair.