OA/TOF Facts

What is oesophageal atresia?

Oesophageal Atresia (OA) is a congenital obstruction in the oesophagus (also known as the ‘gullet’) in newborn babies. In this condition, the oesophagus ends in a blind upper pouch and is not connected to the stomach.

As a result of this obstruction, food and saliva cannot pass into the stomach. In most cases, the baby with OA also has a Tracheo-Oesophageal Fistula (TOF).

What is a tracheo-oesophageal fistula?

Tracheo-oesophageal fistula (TOF) is where a section of the baby’s trachea (windpipe) is abnormally connected by a small tube (fistula) to the baby’s oesophagus.

How does TOF/OA occur?

The oesophagus and trachea actually form from the one tube. OA and TOF are believed to happen when the oesophagus and trachea fail to differentiate and separate properly. Research is continuing into the cause of TOF/OA and at this stage the cause is not known.

Are there other abnormalities associated with TOF/OA?

Approximately half the babies born with TOF/OA have other abnormalities. This is why a number of investigations are undertaken to see if your baby has any additional problems. Some babies are born with abnormalities of the spine, heart, kidneys, anus and/or radial bone (a bone in the lower arm). If a baby has three or more of these abnormalities, it has what is known as “VACTERL association”.

VACTERL is an acronym where the letters stand for vertebral, anal, cardiac, tracheal (TOF), oesophagus (oesophageal atresia), renal and limb.

How common is TOF/OA?

TOF/OA occurs once in every 3,500 live births.

How is the TOF/OA repaired?

In most babies with OA and a distal TOF, surgeons can operate to close the TOF and join the two ends of the oesophagus within the first few days of life. The incision is usually made on the right side of the chest, under the baby’s arm towards their back.

The TOF is divided and the tracheal end of the fistula is repaired with sutures. The two ends of the oesophagus are then brought together, and the upper oesophageal pouch is opened and joined to the lower oesophagus.

In some cases, the gap between the two ends of the oesophagus may be too large to enable an immediate repair of the oesophagus. Occasionally, the baby may be premature or too sick for the surgery to be undertaken.

If this is the case, the baby will have surgery to close the TOF and the oesophagus will be repaired at a later date. If the oesophagus is not repaired at the same time as the TOF, a gastrostomy tube may be inserted through the abdominal wall into the baby’s stomach to allow the baby to be fed until further surgery is performed to repair the oesophageal atresia.

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