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OESOPHAGEAL ATRESIA

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Title: OESOPHAGEAL ATRESIA


1
OESOPHAGEAL ATRESIA
  • Anne Aspin
  • 2010

2
Types of oesophageal atresia and fistula
86
7
4
3
Types continued
1
lt1
lt1
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 gt1500 No 96
  • 2 lt1500 or Yes 60
  • 3 lt1500 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)
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