RT Book, Section
A1 Coppi, Paolo De
A1 Pierro, Agostino
A2 Ziegler, Moritz M.
A2 Azizkhan, Richard G.
A2 Allmen, Daniel von
A2 Weber, Thomas R.
SR Print(0)
ID 1100433096
T1 Esophageal Atresia
T2 Operative Pediatric Surgery, 2e
YR 2014
FD 2014
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-162723-8
LK accesspediatrics.mhmedical.com/content.aspx?aid=1100433096
RD 2024/04/20
AB Most  cases  of  esophageal  atresia  and  tracheoesophageal  fistula  (EA/TEF)  occur  sporadically.  In  50%  to  80%  of  cases,  there  are  associated  anomalies,  most  frequently  musculoskeletal  malformations,  followed  by  cardiovascular,  genitourinary,  gastrointestinal,  and  chromosomal  anomalies.Unlike  other  congenital  malformations,  EA  is  infrequently  diagnosed  prenatally.Polyhydramnios  is  present  in  95%  of  patients  with  isolated  EA  without  TEF,  and  in  35%  of  cases  with  distal  TEF.All  infants  with  EA  should  have  an  echocardiogram  before  operative  repair  because  of  the  high  incidence  of  congenital  cardiac  anomalies.In  neonates  with  EA/TEF,  the  diagnosis  can  be  confirmed  by  tracheobronchoscopy  and/or  esophagoscopy.Surgical  repair  should  be  done  soon  after  birth.  It  is  not  an  emergency  procedure,  but  neonates  requiring  mechanical  ventilation  should  be  operated  on  promptly  to  avoid  gastric  distension  and  possible  perforation.Physiological  stable  neonates  with  EA  and  TEF  can  be  managed  with  a  single  operation  to  divide  the  distal  fistula  and  perform  the  esophageal  anastomosis.In  10%  of  neonates  with  EA  and  TEF  who  are  very  premature  or  physiological  unstable,  ligation  of  the  TEF  is  performed  first  and  the  esophageal  anastomosis  is  done  as  a  secondary  stage  repair  when  the  baby  is  stable.Thoracoscopic  repair  offers  a  scarless  repair  with  faster  recovery  and  less  postoperative  pain  and  may  also  potentially  protect  from  later  problems  such  as  winged  scapula  and  thoracic  asymmetry.