OESOPHAGEAL ATRESIA Anne Aspin 2010

Types of oesophageal atresia and fistula 86%7% 4%

Types continued 1% <1<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)