OESOPHAGEAL OESOPHAGEAL ATRESIAATRESIA

OESOPHAGEAL OESOPHAGEAL ATRESIAATRESIAAnne AspinAnne Aspin

20102010

Types of oesophageal atresia and fistula

86% 7%4%

Types continued

1%<1

<1

History• First case recorded Durston (1670)• Gibson (1697) first recorded with

fistula• Ladd (1939) first staged repair• Height (1941) first successful

primary repair.

• Survival rate of around 90%• Incidence 1: 4500• Antenatal diagnosis –

polyhydramnios and absent stomach 56% predictive of OA.

After birth• Large NG tube• CXR, AXR• Replogle tube, 10 min suction to

pharynx

Associated anomalies• 50% associated anomalies• Cardiac 29%

• Vertebral, Anorectal, Cardiac, Tracheo, Oesophageal, Renal, Limb

• CHARGE, Coloboma, Heart defects, Atresia choanal, retarded growth and development, Genital Hypoplasia, Ear

Table 1• Cardiovascular 29%• Gastro intestinal (anorectal 14%)

27%• Genito urinary 13%• Vertebral and skeletal 10%• Respiratory 6%• Genetic 4%

Table 2• Risk classification for OA• Group BW Major cardiac survival defect 1 >1500 No 96% 2 <1500 or Yes 60% 3 <1500 and Yes 18%

Primary repair• Paralyse and ventilate 5 days post

op• Long gap – gastrostomy and

assessment of gap, may leave 6 – 12 weeks before primary closure.

• Gap of more than 6-8 vertebrae, oesophageal replacement

Post operation- early complications

• Anastomotic leak , 27%, 24 – 72hrs

• Anastomotic stricture

• Recurrent tracheo oesophageal fistula

Late complications• Tracheomalacia• Gastro oesophageal reflux• Respiratory problems• Motility disorders• Growth

Research• Family study – broad spectrum• Relatives of TOF have these

anomalies (genetic factor)• Range of medical problems ie

dysmotility, reflux –family have these. (Genetic story to investigate)

• Vitamin A, Adriamycin (cancer drug)