Advances in the treatment of oesophageal atresia over three decades: the 1970s and the 1990s

Abstract

Oesophageal atresia management has evolved alongside the development of paediatric surgery. An analysis of a 30-year prospective collection of oesophageal atresia cases treated at the Royal Alexandra Hospital for Children, NSW, Australia is presented. There has been a dramatic change in the surgical approach. Fewer infants are undergoing operations of cervical oesophagostomy, gastrostomy and oesophageal replacement. More, including fragile infants, are surviving with a repaired native oesophagus. Fewer infants are suffering morbidity secondary to anastomotic leak. The progression in treatment has been enabled by improved neonatal support due to advances in neonatology, neonatal anaesthesia, nutritional support and antimicrobial therapy. Oesophageal atresia treatment and outcome has changed markedly over three decades. Cooperative multi-centre database development is now required to provide data in order to further refine treatment for clinical challenges that remain.

Genetic and environmental factors in the etiology of esophageal atresia and/or tracheoesophageal fistula: An overview of the current concepts

“…It is characterized by a lack of continuity of the upper gastrointestinal tract that is often accompanied with a persistent connection, or fistula, between the trachea and the esophagus (tracheoesophageal fistula [TEF]). Although mortality and complication rates have decreased over the past decades, EA/TEF remains a severe congenital anomaly that may cause significant short-and long-term morbidity (Deurloo et al, 2002;Orford et al, 2004;Tö nz et al, 2004;Goyal et al, 2006). Many genetic and environmental factors have been suggested to play an etiologic role in EA/TEF, but the developmental mechanisms are far from being elucidated (Felix et al, 2004(Felix et al, , 2007b.…”

A patient led, international study of long term outcomes of esophageal atresia: EAT 1

“…Outcomes in oesophageal atresia (OA) have improved in the last 50 years with survival now of more than 90% [1][2][3] leading to an increasing population of long term survivors. Whilst our understanding of short term outcomes in infants with OA is good [4][5][6][7], longer term functional outcomes are more poorly understood with a limited research base [8][9][10].…”

Increasing Prevalence of Medically Complex Children in US Hospitals

“…[5][6][7][8][9][10][11][12][13] Surgical advances have resulted in an improved survival rate for infants with certain congenital defects including diaphragmatic hernia, abdominal wall defects, esophageal atresia, and cyanotic heart defects. [14][15][16][17][18] Many of these children have systemic health problems including neurodevelopmental disabilities, gastrointestinal illnesses, pulmonary complications, musculoskeletal abnormalities, and nutritional deficits. [5][6][7]13,19,20 These conditions may require frequent hospital and subspecialty care.…”