1. OESOPHAGEAL ATRESIA Anne Aspin 2010

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

3. Types continued 1% <1<1 <1<1

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

5. Survival rate of around 90% Incidence 1: 4500 Antenatal diagnosis – polyhydramnios and absent stomach 56% predictive of OA.

6. After birth Large NG tube CXR, AXR Replogle tube, 10 min suction to pharynx

7. Associated anomalies 50% associated anomalies Cardiac 29% Vertebral, Anorectal, Cardiac, Tracheo, Oesophageal, Renal, Limb

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

9. Table 1 Cardiovascular 29% Gastro intestinal (anorectal 14%) 27% Genito urinary 13% Vertebral and skeletal 10% Respiratory 6% Genetic 4%

10. 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%

11. 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

12. Post operation- early complications Anastomotic leak, 27%, 24 – 72hrs Anastomotic stricture Recurrent tracheo oesophageal fistula

13. Late complications Tracheomalacia Gastro oesophageal reflux Respiratory problems Motility disorders Growth

14. 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)