University Hospital Southampton NHS Foundation Trust

Oesophageal atresia and tracheo-oesophageal fistula (TOF)

TOFIf your child has a problem with the oesophagus (the feeding tube) and the trachea (the windpipe), this is called tracheo-oesophageal fistula (TOF) and oesophageal atresia (OA).

The fistula is a connection between the trachea and the oesophagus which may lead to problems with breathing. An atresia means that there is no way for food to pass into the stomach due to the gap between the upper and the lower parts of the oesophagus, so an operation will be needed to correct these problems.

Some babies with TOF often have other problems, including the development of the kidneys, problems with their bottom (anorectal abnormalities) and other areas.

Treatment

Once diagnosed it is important that your baby stops feeding and fluids are given using a drip. Additionally, a small tube is passed through the baby's nose or mouth down into the pouch of the oesophagus to suck out any secretions as your baby swallows. This is called a Replogle tube and it remains in place until the operation.

The aim of the operation is to close the fistula and repair the oesophagus. The type of operation will depend on the defect that is found during the procedure. It will be done under general anaesthetic and your baby will be given some painkillers once they return from theatre.

Your baby may be on a ventilator (breathing machine) for a while. This may be to allow the repair to settle down and, because some painkillers that we use can slow your baby's breathing down, we use a ventilator to enable us to give the strongest, most effective dose.TOF2

Feeding

After the operation, a feeding tube is passed through the nose and the repaired oesophagus and into the stomach. This enables your baby to be fed through the tube, in most cases, within a few days of surgery.

When your baby is ready to start having feeds, a small amount is given frequently to begin with, before increasing to the required amount. An X-Ray be done prior to this to make sure that the repaired area has healed. as the amount of food increases, you will be able to breast feed if you wish.

Discharge and follow up

This depends on your baby's recovery from the operation as well as the length of time it has taken to achieve complete oral feeding. In most cases your baby's stay will be between 7-10 days.

Taking home a baby who has had this procedure can be very daunting. Prior to being discharged, you must be aware that there are a number of complications your baby may encounter. These problems will be described to you in detail after the surgery. Therefore, it is important that you are able to use some emergency first aid in case it is ever needed. Before you take your baby home, you will have an opportunity to participate in a practical demonstration using a dummy baby.

Follow up appointments will be made with the consultant surgeon in the outpatient department either in Southampton General Hospital or in your local hospital. This may continue for a few years. If you have any worries or concerns, please contact us.

Parent to parent link

Many parents who have experienced this condition with their baby have said they would be willing to speak to other parents about their experience. If you would like to speak to another family, please contact us.

Disclaimer

University Hospital Southampton NHS Foundation Trust produce guidelines as an aid to good clinical practice. They represent recognised methods and techniques of clinical practice, based on published evidence. The ultimate judgement regarding a particular clinical procedure or treatment must be made by the clinician in the light of the clinical data presented by the patient and the diagnostic or treatment options available. The guidelines issued are not intended to be prescriptive directions defining a single course of management and departure from the local guidelines should be fully documented in the patient's case notes at the time the relevant decision is taken.