Esophageal Atresia Repair

Esophageal atresia repair is a type of surgery that is done to fix a congenital defect called esophageal atresia. This type of defect is present at birth. Esophageal atresia occurs when the upper part of the esophagus is not connected to the lower part. The esophagus is the part of the body that carries food from the throat to the stomach. In this condition, the upper part of the esophagus ends in a pouch instead of going to the stomach. Babies with this condition cannot eat or drink.

Most children who have esophageal atresia also have a defect that involves an abnormal connection called a fistula between the windpipe (trachea) and the esophagus. This defect is called a tracheoesophageal fistula. Fluids from the esophagus may leak through the fistula into the baby's lungs and cause breathing problems or a lung infection, also called pneumonia. Both of these defects are very dangerous for the baby, but they can be corrected. Most children who have esophageal atresia repair grow up without medical problems and can take part in the same activities as other children.

Tell a health care provider about:

• Any problems you or family members have had with anesthetic medicines.
• Any medical conditions you or family members have, including blood disorders.

What are the risks?

• Infection.
• Bleeding.
• Leaking of food or liquids from the surgical area.
• Damage to the esophagus or trachea. This may include stenosis, or narrowing of the esophagus from scar tissue that blocks swallowing.
• Allergic reactions to medicines.
• Low body temperature (hypothermia) or a collapsed lung (pneumothorax).
• A backup of stomach acid (reflux) into the throat that causes spitting, coughing, and heartburn. The baby may cry as a result.
• The fistula developing again, or recurring, after surgery.

What happens before the procedure?

• After your baby is diagnosed, he or she will be taken to the infant (neonatal) intensive care unit (NICU). In the NICU:
  • An IV will be inserted into one of your baby's veins, usually in the chest or the umbilical cord. Your baby will be given antibiotic medicine through the IV to help prevent infection.
  • A tube may be placed into your baby's trachea (endotracheal tube) and connected to a machine called a ventilator that helps your baby to breathe.
  • A drain tube will be placed through your baby's nose or mouth and into the throat. This tube will drain fluids that collect during surgery.
• Ask your baby's health care provider:
  • How the surgery site will be marked.
  • What steps will be taken to help prevent infection. These steps may include washing skin with a germ-killing soap.

What happens during the procedure?

• Your baby will be given a medicine through an IV to make him or her fall sleep (general anesthetic).
• An incision will be made on the right side of the chest.
• An opening will be made between the ribs, to allow access to the inside of the right lung.
• If there is a tracheoesophageal fistula, the surgeon will close it so that fluids can no longer leak into the trachea or lungs.
• The pouch end of the upper part of the esophagus will be opened.
• The top end of the lower part of the esophagus will be opened.
• The two ends of the esophagus will be connected with stitches (sutures). If the two ends are not long enough, part of the stomach or colon could be used to attach the two ends of the esophagus.
• A stomach tube will be passed through the esophagus and into the stomach.
• The chest incision will be closed with sutures, skin glue, or adhesive strips.
• A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your baby will stay in the NICU in a warm crib (isolette) for a week or longer.
• Your baby will receive fluids, pain medicine, antibiotics, and nutrition through the IV.
• Your baby's stomach tube will be suctioned regularly. This clears fluid from the stomach.
• Your baby may still need an endotracheal tube and ventilator for a few days for breathing support.
• After about 1 week, X-rays will be taken of your baby's chest and esophagus. If the X-rays are normal:
  • Your baby may start feedings with formula or with pre-pumped (expressed) breast milk.
  • The stomach tube and IV will be removed after your baby is eating well.
• You may be referred to a support group or feeding program to help your baby learn to eat.

Summary

• Esophageal atresia repair is a type of surgery that is done to fix a defect present at birth and known as esophageal atresia.
• Esophageal atresia occurs when the upper part of the esophagus is not connected to the lower part. This means that your baby cannot eat or drink.
• Most children who have esophageal atresia also have a defect that involves an abnormal connection between the windpipe (trachea) and the esophagus. This defect is called a tracheoesophageal fistula.
• Most children who have this surgery grow up without medical problems and can take part in the same activities as other children.
• After the procedure, your baby will stay in the NICU in a warm crib (isolette) for a week or longer.