Advances in the treatment of oesophageal atresia over three decades: the 1970s and the 1990s.

Oesophageal atresia management has evolved alongside the development of paediatric surgery. An analysis of a 30-year prospective collection of oesophageal atresia cases treated at the Royal Alexandra Hospital for Children, NSW, Australia is presented. There has been a dramatic change in the surgical approach. Fewer infants are undergoing operations of cervical oesophagostomy, gastrostomy and oesophageal replacement. More, including fragile infants, are surviving with a repaired native oesophagus. Fewer infants are suffering morbidity secondary to anastomotic leak. The progression in treatment has been enabled by improved neonatal support due to advances in neonatology, neonatal anaesthesia, nutritional support and antimicrobial therapy. Oesophageal atresia treatment and outcome has changed markedly over three decades. Cooperative multi-centre database development is now required to provide data in order to further refine treatment for clinical challenges that remain.