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What is the management for tracheo-oesophageal fistula?

Q: Our child is 7 months old and she has TOF / TEF - tracheo-oesophageal fistula with a long gap of 4 cms, detected at birth but unable to do corrective surgery due to long gap. Now she is on with the gastrostomy tube and pharyngostomy has been done. At birth she was 2.6 kg; after first days surgery she weighed 2.2 kg; Now she is 6.04 kg. We have been advised that corrective surgery will be done when she about 10 - 12 kg. Now she is stable except, at times throat infection, and presently severe cough & cold (with running nose and thick secretions). She has been examined and given medication. She is undergoing treatment at the Institute of Child Health, Chennai, where she is treated by the chief doctor and his team as a special case. What are the latest development in this field and what are the latest procedures in surgery and in day to day care of such children?

A:I am certain that your child is in good hands. The main factor is that your baby is gaining weight. These children are predisposed to chest infections that may happen from time to time. She will need an oesophageal substitution procedure in which the food pipe would need to be reconstructed. This is usually done between 6-12 months of age. Opinion at different centres may vary regarding when to operate. The best guide should be the baby's health. Differences may also be there regarding which segment of the intestinal tract to use to reconstruct the food pipe. Much depends on the experience of the treating surgeon and his preferences. Overall, the results with all forms of surgery are about the same. It is a big operation with some immediate and some long term worries. You must discuss all these with your treating surgeon. By and large, treatment anywhere in the world would be along these standard lines.

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