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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

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oesophageal atresia

OESOPHAGEAL ATRESIA

Anne Aspin

2010

history
History
  • First case recorded Durston (1670)
  • Gibson (1697) first recorded with fistula
  • Ladd (1939) first staged repair
  • Height (1941) first successful primary repair.
slide5
Survival rate of around 90%
  • Incidence 1: 4500
  • Antenatal diagnosis – polyhydramnios and absent stomach 56% predictive of OA.
after birth
After birth
  • Large NG tube
  • CXR, AXR
  • Replogle tube, 10 min suction to pharynx
associated anomalies
Associated anomalies
  • 50% associated anomalies
  • Cardiac 29%
  • Vertebral, Anorectal, Cardiac, Tracheo, Oesophageal, Renal, Limb
slide8
CHARGE, Coloboma, Heart defects, Atresia choanal, retarded growth and development, Genital Hypoplasia, Ear
table 1
Table 1
  • Cardiovascular 29%
  • Gastro intestinal (anorectal 14%) 27%
  • Genito urinary 13%
  • Vertebral and skeletal 10%
  • Respiratory 6%
  • Genetic 4%
table 2
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
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
Post operation- early complications
  • Anastomotic leak , 27%, 24 – 72hrs
  • Anastomotic stricture
  • Recurrent tracheo oesophageal fistula
late complications
Late complications
  • Tracheomalacia
  • Gastro oesophageal reflux
  • Respiratory problems
  • Motility disorders
  • Growth
research
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)