Complications
Faltering growth is common among children who have undergone oesophageal atresia repair.[49]
In one long-term follow-up study, around 80% of adults who had oesophageal atresia/tracheo-oesophageal fistula (OA/TOF) surgically corrected as infants complained of some difficulty swallowing. While many stated that this did not affect their overall quality of life or food choices, 13% required endoscopic foreign body removal.[38]
One systematic review summarising 65 peer-reviewed publications found high rates of oesophagal dysmotility, GORD, esophagitis, and dysphagia in patients with a history of surgically corrected OA.[39] GORD occurs due to poor oesophageal motility and a congenitally short oesophagus. After a 10-year follow-up, 100% of patients in one study were found to have oesophageal dysmotility by manometry.[40] The initial method of therapy is medical treatment, but 50% of patients will require an anti-reflux procedure.[13][41][42][43][44]
Long-term surveillance of GORD after OA/TOF repair is required given the incidence of ongoing oesophagitis.[45] In one study, the incidence of intestinal metaplasia was 10 times higher than in the general paediatric population.[46]
Typically, patients present with choking, gagging and feed intolerance.[47] This can occur due to GORD or secondary to tension and resultant stricture of the anastomosis site. Initial treatment includes H2 blockers, and approximately 10% to 20% of patients will require 1 or more oesophageal dilations.[44][48]
Often the cartilaginous wall of an infant with tracheo-oesophageal fistula is weak. This wall may collapse during inspiration causing near complete airway obstruction. This may result in symptoms which range from noisy breathing and severe dyspnoea on exertion to near death or cyanotic spells. If these symptoms occur, the patient should be referred for bronchoscopy. If the patient has significant GORD, bronchoscopy may worsen symptoms. Symptoms usually resolve as the trachea matures and the cartilages become stiffer; however, severe cases may require procedures such as an aortopexy, tracheopexy or even tracheostomy.
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