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Children born with oesophageal atresia with or without trachea-oesophageal fistula usually receive early surgical repair to create tension-free anastomosis that facilitates oral feeding. However, many children are at risk of problems related to subsequent dysphagia. This includes respiratory, nutritional, motility and digestive problems as well as stressful interactions between children and their caregivers. The authors of this paper carried out a survey to establish the perspectives of paediatric surgeons in Turkey regarding the management of dysphagia in this patient group. The majority of the 72 surgeons (57%) who responded had operated on between one and five cases per annum, 26% between five and 10 cases, and the remainder operated on more than 10 cases per year. Only a fifth of surgeons used a standardised protocol to assess dysphagia, with 80% reporting that they lacked appropriate team support for dysphagia management at their clinical settings. It was evident from the survey that the surgeons had good awareness of dysphagia, with over 90% indicating that they would be interested in training on dysphagia management. Most usefully, the qualitative aspects of the survey provided an opportunity to make recommendations for improving the service to children with this condition. Key recommendations include the following: 1) Surgery is performed to achieve oral feeding. Dysphagia should therefore be addressed early as it increases surgical success; 2) Family meetings should be part of the management plan and disruptions to follow-ups should be avoided; 3) Expert centres should be established; 4) Expert training should be organised in clinics and congresses; 5) Consensus should be established on best practice for equipment and team facilities; and 6) A multidisciplinary approach should be encouraged. The results of this survey are interesting in that they highlight what is likely to be an issue for this specialist condition, replicated in many other countries too. Primarily, it draws attention to the fact that treating a physical defect with surgery is only part of the management plan and that multidisciplinary approaches are essential for holistic care and best outcomes.

Dysphagia in Children with EA-TEF From the Perspective of Pediatric Surgeons in Clinical Settings.
Arslan SS, Demir N, Karaduman AA, Soyer T.
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Roganie Govender

University College London, Head & Neck Academic Centre, UK.

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