literature exists on the advantages of ligating. If the fistula is not ligated initially,
attention must be paid to how much of positive pressure breaths are transmitted into the
G tube. The tube may need to be placed under water pressure to force the positive
pressure breath into the lungs.
There are some case series that advocate a staged approach to EA/TEF repair
in very low birth weight infants <1.5 kg (CHLA). These infants would get their
tracheoesophageal fistulas ligated prior to the definitive esophagoesophagostomy.
Fistula ligation would decrease the contamination of the respiratory tract from the
stomach. These patients can be enterally fed into their stomach if a G tube is placed.
The typical repair consists of a posterolateral thoracotomy on side opposite aortic
arch. The fistula is identified, divided and repaired on the trachea side. The proximal
esophagus is identified and an esophagoesophagostomy
Surgical Repair/Management of Isolated EA
Typically isolated EA has very long gap (defined as > 2 vertebral body gap
between the proximal and distal pouches. We wait 6-12 weeks to attempt to repair
these babies in order to achieve primary esophageal anastomosis. While waiting a G
tube is placed in these babies to feed them enterally. Bolus feeds are given to the
babies in temporal synchrony with oral stimulation, to train them into associating feeding
with feelings of satiety. Bolus feedings also enlarge the stomach, and potentially
distends and elongates the distal esophageal remnant.
The repair