The treatment of esophageal atresia and tracheoesophageal fistula, although still a challenge, represents one of the true successes of newborn surgery. Thomas Gibson first described the classic form of esophageal atresia with tracheoesophageal fistula in 1697 . In 1888, Charles Steele attempted the first surgical repair of a pure esophageal atresia. He carried out a gastrotomy and attempted to pass a steel probe through the suspected esophageal membrane. At autopsy, the probe exited the lower esophageal pouch but the two ends of the esophagus were noted to end blindly with a gap between them of 1.5 inches with no connection that could be identified . Attempted repair of esophageal atresia with a tracheoesophageal fistula employing fistula division and primary anastomosis was first reported by Robert Shaw in Dallas in 1938  but first attempted by Thomas Lanman in Boston in 1936, who later reported it along with 4 other attempts and 27 additional cases of esophageal atresia in 1940 . All of these attempts were unsuccessful, but not all because of technical issues. After 5 failed attempts, the first in 1939, Cameron Haight undertook the first successful primary repair of esophageal atresia in 1941 using a left extrapleural approach, fistula ligation, and a single-layer anastomosis . Over the years, improvements in surgical technique and neonatal care have improved outcomes in the treatment of esophageal atresia and tracheoesophageal fistula. In 1994, Spitz et al. Created a system to stratify outcome based on birth weight (>1,500 g or <1,500 g) and the presence of a major cardiac anomaly . In 2006, Spitz compared results in the present era to the 1994 results and noted that survival of babies with birth weight >1500 g and no cardiac anomalies was similar: 97% in 1994 versus 98.5% in 2006. Survival for babies that weighed <1,500 g at birth, or had a cardiac anomaly, improved from 59% to 82% during that interval. The babies with the worst outcomes, those that weighed <1,500 g at birth and had a cardiac anomaly, improved from 22% in the early era to 50% . In 2009, Okamoto et al. Reviewed the Japanese experience, and proposed a modification to the Spitz classification depicted in Table 8.1 .
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