Transcript Oesophageal atresia and TOF

OESOPHAGEAL
ATRESIA
Anne Aspin
2010
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)