Surgery to Fix the Esophagus (Esophageal Atresia Repair) in Infants: What to Expect

Esophageal atresia is a problem that some babies are born with. It happens when the upper part of the esophagus ends in a pouch. The pouch isn't connected to the stomach. When this happens, food can't move from the throat to the stomach like it should. This means babies can't swallow food normally and they need surgery to fix it.

The surgery to fix esophageal atresia will connect the end of the esophagus to the stomach. This may be done during one surgery, but for some babies, more than one surgery will be needed.

Many babies who have esophageal atresia also have a connection between the esophagus and the airway, or trachea. This connection is called a tracheoesophageal (TE) fistula. This fistula is also repaired during the surgery.

What are the risks?

• Infection.
• Breathing problems.
• Leakage from the new connection.
• Scar tissue forming around the connection. This can cause narrowing of the esophagus after surgery.
• A new fistula, or connection, forming between the esophagus and the airway.

What happens before?

• Your baby will be cared for in an intensive care unit for babies or children. The following will happen to keep your baby safe until surgery can take place:
  • A drain tube will be placed through your baby's nose or mouth and into the throat. This tube will drain fluids that collect in the pouch and prevent choking.
  • An IV will be put into one of your baby's veins. Your baby will get fluids and nutrition through the IV.
  • If needed, a tube will be placed into your baby's airway. This is called an endotracheal tube, or ET tube. It will be connected to a machine called a ventilator that helps your baby to breathe.
• For your baby's safety, they may:
  • Need to have their skin washed with a soap that kills germs.
  • Have their surgery site marked.

What happens during the surgery to fix the esophagus?

• Your baby will be given anesthesia to keep them from feeling pain.
• The surgeon will make a cut on your baby's chest to reach the esophagus and stomach.
• If there's a TE fistula, the surgeon will close it so that fluids can no longer leak into the airway.
• The upper pouch of the esophagus will be connected to the lower part of the esophagus or the stomach.
• A new drain tube will be passed from your baby's mouth or nose all the way into the stomach.
• If needed, another tube, called a chest tube, may be placed to drain fluids from the chest.
• The cut made on the chest will be closed, and a bandage will be placed over the cut.

These steps may vary. Ask what you can expect.

What happens after?

• Your baby will receive fluids, pain medicine, antibiotics, and nutrition through the IV.
• Your baby's drain tube that goes into the nose or mouth will keep the stomach empty while the connection heals.
• Your baby may still need an ET tube and ventilator for a few days.

Reach out to your baby's health care team with questions about your baby's care.