Esophago-esophagostomy is preferred (may be tight).
If unable to do so, consider gastric or colonic transposition.
If unable to achieve primary esophageal continuity and reluctant to do primary
esophageal replacement, cervical esophagostomy can be performed. The proximal
esophageal pouch brought out on left neck allowing salivary secretions to drain and not
be aspirated into the lungs. An esophagostomy automatically buys an eventual
esophageal replacement with stomach or colon.
Surgical Repair of H-Type TEF
H type TEF’s are usually higher than those associated with esophageal atresia.
These are not repaired through a thoracotomy. The operation starts with a rigid
bronchoscopy to identify the fistula. A Fogarty balloon catheter is inserted into fistula
and passed into the esophagus. The balloon is inflated. An esophagoscopy usually is
done to confirm catheter placement. The fistula ligation is usually done via a low right
cervical approach
Postoperative care
A CXR is done post-operatively to assess the lung fields and document the
placement of the chest drain, epidural catheter, and endotracheal tube when applicable.
The ETT tube should have the tip well above the carina. Manipulation of he ETT is kept
at a minimum.
The post operative care is usually straightforward. If needed, assisted ventilation is
provided. Reintubation and ETT manipulation must be done with extreme care, after