ECMO-/ECLS

Recurrent TEF occur seldomly. Surgeons attempt to put intervening tissue or
graft(Surgisys) between the tracheal repair and the esophageal anastomosis to prevent
this complication.
Children with TEF can have varying degrees of airway compromise due to
tracheomalacia or laryngomalacia. Tracheomalacia is one of the differential diagnoses
in children with apenea and bradycardia episodes after definitive surgery. (Other
etiologies include sever GER with reflux and bronchospasm, recurrent TEF,
laryngotracheal clefts, undiagnosed cardiac anomalies. A rigid bronchoscopy in a
spontaneously breathing child is required to make the diagnosis of tracheomalacia; the
posterior trachea coapts with the anterior trachea during expiration. If tracheomalacia is
severe, an aortopexy (aorta is pexed to the underside of the sternum) may be
necessary.
Gastroesophageal reflux is seen in most TEF/EA patients. It is hypothesized that
the distal esophageal dissection added to the cephalad pull on the distal esophagus
straightens out the gastroesophageal junction, leading to increased reflux in this
population. If reflux leads to recurrent aspiration pneumonias, significant apnea, emesis
leading to failure to thrive, repeated episodes of anastomotic stricture, a fundoplictaion
may be necessary.