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Updates in: Oesophageal Atresia with or without Tracheoesophageal Fistula - Abstract

Alexander L. Macdonald, Simon A. Clarke



Oesophageal atresia with or without tracheoesophageal fistula represents a spectrum of pathology and over half of infants will have associated congenital co-morbidites which may be life-threating and account for significant morbidity and mortality. Antenatal features are non-specific and detection rates vary considerably requiring prompt post-natal recognition of symptomatic infants. Peri-operative surgical and anaesthetic practice is variable. Recent advances in surgical technique include the adoption of the minimally invasive thoracoscopic approach and outcomes are at least comparable to conventional open repair. Regardless of approach post-operative complications particularly anastomotic stricture are frequent and may require several re-interventions. Long gap oesophageal atresia represents a complex subset of patients who may require oesophageal replacement and the optimum approach to such cases remains contentious. Long-term gastrointestinal and respiratory morbidity is often significant and requires multidisciplinary follow-up. Future advances include tissue engineering techniques which have the potential to produce oesophageal replacement grafts with anatomical and functional attributes equivalent to native tissue. In this highly complex low volume pathology, re-configuration and centralisation of management to higher volumes centres has potential to improve patient outcomes.

Keywords: oesophageal atresia, tracheooesophageal fistula


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