Most OA/TOF babies will reflux. Reflux is the return of stomach contents back up the oesophagus. Minor degrees of reflux are common in all newborn babies which is why they possit (bring up small mouthfuls of milk after feeding).
Gastro-oesophageal reflux (GOR) is caused by weakness of a valve at the top of the stomach called the lower oesophageal sphincter. This is another common problem seen with oesophageal atresia. Sometimes stomach acid regurgitates up the oesophagus where it can cause inflammation and pain.
In adults, this causes heartburn. In babies, it can discourage them from feeding.
A variety of medicines and food thickeners are used to treat reflux. However, if medication does not control the symptoms, particularly if reflux is causing recurrent aspiration and chest infections, anti-reflux surgery may be necessary.
This surgery is called fundoplication.
The basic elements of the options available are similar:
The fundoplication wrap recreates a valve between the oesophagus and stomach. It also restores the angle of His (the angle between the stomach and the oesophagus).
The wrap should be loose so that when the stomach is relaxed and the oesophagus squeezes during swallowing, the contents of the oesophagus pass freely into the stomach.
When the stomach contracts to empty, the wrap also contracts, closing the lower oesophagus and preventing reflux of gastric contents.
There are several variations of the fundoplication operation, each referred to by the name of the surgeon who first described it:
Nissen was a German surgeon who described a fundoplication with a 360° wrap in the 1960s. This operation is probably the one most often performed in the UK today.
Toupet, Watson and Thal operations involve partial wraps around the oesophagus. The potential advantage of a partial wrap is a lower incidence of dysphagia (difficulty swallowing solids) after surgery, although this may be at the cost of a less efficient barrier to reflux.
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