What is TOF/OA?

Tracheo-oesophageal fistula (TOF) and oesophageal atresia (OA) are rare congenital conditions of the oesophagus (food pipe) and/or trachea (airway) that affect one in every 3,500 babies. Babies born with TOF/OA need to have intensive neonatal care prior to corrective surgery, normally within days of birth. Some children have to undergo additional surgical interventions later on in their lives. Whilst many children born with TOF/OA will experience only a few problems, others may have difficulties with swallowing and digesting food, gastro-oesophageal reflux (where the acidic stomach contents pass back into the lower oesophagus) and respiratory problems. The effects of surgery and associated health problems can add a great deal to the usual challenges of parenthood.

What is wrong in TOF/OA?

The oesophagus (gullet or ‘foodpipe’) is the passage through which food moves on its route from the mouth to the stomach.
It starts in the neck, just behind the larynx (Adam’s apple), and ends below the diaphragm where it joins the stomach at an acute angle.

The word ‘atresia’ is taken from ancient Greek and means ‘no passage / no way through.’ Thus in oesophageal atresia there is a break in the continuity of the oesophagus. The end nearest the mouth is not attached to the end which enters the stomach, the gap usually occurring high up in the chest. The presence of a blindending pouch in the upper oesophagus means that food is unable to reach the stomach; any swallowed milk or saliva
instead returns to the mouth.

The trachea (windpipe) starts at the larynx (the voice box, seen from the
outside as the ‘Adam’s apple’ in the neck) and passes in front of the oesophagus before it enters the upper chest, where it divides into two tubes, the main bronchi, which go to the right and left lungs.


A fistula, from the Latin meaning ‘a pipe,’ is an abnormal connection running either between two tubes or between a tube and a surface. In tracheo-oesophageal fistula it runs between the trachea and the oesophagus. This connection may or may not have a central cavity; if it does, then food within the oesophagus may pass into the trachea (and onto the lungs) or alternatively, air in the trachea may cross into the oesophagus.


i) the two ends of the oesophagus must be joined together to allow the baby to swallow food such that the nutrients it contains can be digested and absorbed.

ii) any connection(s) with the trachea must be closed off to prevent swallowed food/fluids passing from the oesophagus into the lungs – also to stop air passing from the trachea to the oesophagus and then into the stomach.

Content provided by JAS Dickson FRCS FRCSE FRCPCH,
Consultant Paediatric Surgeon, Sheffield Children’s Hospital. From TOFS website.

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