Management of Oesophageal Atresia and Tracheo-Oesophageal Fistula: A Prospective Study of 30 Consecutive Cases

Background: Oesophageal atresia with tracheo-oesophageal fistula (OA/TOF) is a life-threatening congenital anomaly requiring immediate surgical intervention. Despite advances in surgical techniques and perioperative care, the condition continues to present significant challenges, particularly in developing countries where late presentation and associated complications are common. Objectives: To describe the management outcomes of OA/TOF, identify perioperative complications, and evaluate the association of prognostic factors with surgical outcomes. Methods: A prospective observational study was conducted over 22 months (November 2018 to August 2020) at J.J.M Medical College, Davanagere, involving 30 consecutive neonates with OA/TOF. All patients underwent detailed clinical assessment, radiological evaluation, and surgical management via right posterolateral thoracotomy with primary oesophago-oesophagostomy. Results: The cohort comprised 60% males and 40% females (male:female ratio 1.5:1). Gross type C was the predominant anatomical variant (96.66%). Low birth weight was present in 66.66% of cases, pneumonia in 56.66%, and associated congenital anomalies in 46.66%. Twenty-nine patients (96.66%) underwent primary repair. Overall mortality was 53.33%, with sepsis (50%) and respiratory failure (37.5%) being the leading causes of death. Postoperative complications included anastomotic leak (43.5%), dysphagia (48.3%), and stricture formation (14.3%). Waterston group A patients demonstrated 100% survival, group B 60% survival, and group C 29.4% survival. Conclusion: Primary thoracotomy with oesophageal anastomosis remains the definitive surgical treatment for Gross type C OA/TOF. Significant postoperative complications and high mortality rates are influenced by low birth weight, pneumonia, sepsis, associated congenital anomalies, and anastomotic leak. Multidisciplinary care involving neonatologists, paediatric surgeons, and intensivists is essential for improving outcomes.