Oesophageal atresia and tracheo-oesophageal fistula

Abstract Oesophageal atresia (OA), or one of its variants, occurs in about 1 in 4500 live births. A distal tracheo-oesophageal fistula coexists in 85% of major variants. Management of OA involves a logical approach to the determination of the anatomical type and early recognition of associated abnormalities that might influence the timing of repair. This chapter provides an overview of the antenatal ultrasonographic features, clinical presentation, confirmation of the anatomical type, and identification of associated abnormalities—many of which follow recognized patterns such as the VACTERL and CHARGE associations and chromosomal abnormalities. Details of the initial resuscitation and surgical treatment are described. For the common type, the distal tracheo-oesophageal fistula is divided and the oesophageal ends are anastomosed, a procedure that can be performed through an open or thoracoscopic approach. A gasless abdomen indicates the absence of a distal fistula, and in these patients, the gap between the oesophageal ends is often long, making the management of this situation complex. Complications of surgery include anastomotic leak, oesophageal stricture, and recurrent fistula. Prematurity, tracheomalacia, and gastro-oesophageal atresia add to the complexities of post-operative care. Survival is determined by the associated abnormalities rather than by oesophageal atresia itself.