OESOPHAGEAL ATRESIA

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OESOPHAGEAL ATRESIA

• Anne Aspin
• 2010

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Types of oesophageal atresia and fistula
86
7
4
3
Types continued
1
lt1
lt1
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History

• First case recorded Durston (1670)
• Gibson (1697) first recorded with fistula
• Ladd (1939) first staged repair
• Height (1941) first successful primary repair.

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• Survival rate of around 90
• Incidence 1 4500
• Antenatal diagnosis polyhydramnios and absent
  stomach 56 predictive of OA.

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After birth

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

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Associated anomalies

• 50 associated anomalies
• Cardiac 29
• Vertebral, Anorectal, Cardiac, Tracheo,
  Oesophageal, Renal, Limb

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

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Table 1

• Cardiovascular 29
• Gastro intestinal (anorectal 14) 27
• Genito urinary 13
• Vertebral and skeletal 10
• Respiratory 6
• Genetic 4

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Table 2

• Risk classification for OA
• Group BW Major cardiac survival
• defect
• 1 gt1500 No 96
• 2 lt1500 or Yes 60
• 3 lt1500 and Yes 18

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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

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Post operation- early complications

• Anastomotic leak , 27, 24 72hrs
• Anastomotic stricture
• Recurrent tracheo oesophageal fistula

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Late complications

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

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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)