later). If the baby, shows discoordinated oral motor skills, he or she may need
evaluation by speech therapy
Evaluation for other anomalies should be completed.
Complications
Anastomotic leaks are usually seen in 30-70% of esophageal repairs. The wider
the gap between the upper and lower esophagus portends higher leak rates. Leaks are
documented during esophagrams scheduled at a pre-determined time after repair.
Majority are small, sub-clinical, and resolve with time. In contrast, anastomotic
disruptions are symptomatic and present with pneumothorax and/or hydrothorax. The
leak from the anastomosis is large enough that the thoracic drain cannot handle the
salivary secretions and swallowed air. It requires surgery to make certain that the area
is adequately drained, and the lung is able to inflate fully. An attempt a re-doing the
repair is usually not done, since the tissues are often friable and contaminated. Any
leaks associated with esophageal anastomosis increases the likelihood of a stricture.
Esophageal strictures are sually seen 2-6 weeks post-operatively and present
with inability to handle secretions, apnea/bradycardia episodes (from oropharyngeal
aspirations). The causes of strictures are multifactorial and may include anastomotic
tension, local vascular insufficiency, and tissue fragility leading to leak.
Gastroesophageal reflux which is commonly seen in babies who have TEF/EA can also
contrite to stricture. Baloon dilation is the current standard of care and may be required
several times.