Esophageal Atresia ± Tracheoesophageal Fistula Flashcards
(19 cards)
Why does Esophageal Atresia (EA) happen?
Anything that stops the separation of the foregut will lead to EA.
Esophageal atresia ± Tracheoesophageal Fistula is part of which widely recognized patterns/syndromes?
1) VACTERL
2) CHARGE
VACTERL stands for:
V – Vertebral defects
A – Anal atresia (imperforate anus)
C – Cardiac defects (e.g., ventricular septal defect)
TE – Tracheo-Esophageal fistula with or without esophageal atresia
R – Renal anomalies
L – Limb abnormalities (e.g., missing thumbs, radial aplasia)
CHARGE stands for:
C – Coloboma (a defect in the eye, such as a missing piece of the iris or retina)
H – Heart defects
A – Atresia of the choanae
R – Retardation of growth and/or development
G – Genital anomalies (especially underdeveloped genitals in males)
E – Ear anomalies and/or hearing loss
What is the most common type of EA ± TEF?
Proximal EA + Distal TEF
What are 2 nonspecific antenatal signs for EA ± TEF?
1) Polyhydramnios
2) Absent or small stomach bubble
What are 2 postnatal signs for EA ± TEF?
1) Excessive salivation
2) Coiled NG tube in the blind upper
pouch around T2–T4 on chest x-ray
How can we assign the type of EA?
Presence/absence of gas in the stomach
and bowel on abdominal x-ray ± Contrast study
If a baby is born with no anus, what should you look for?
EA ± TEF
Is EA ± TEF an emergency?
No
Preoperative measures we should take for EA ± TEF?
1) Continuous suctioning tube in the upper
esophagus
2) Head-up position & on the side
3) If in respiratory distress → gentle low pressure ventilation
Preoperative work up for EA ± TEF?
1) Echocardiography (to r/o cardiac &/or aortic arch anomalies)
2) Renal ultrasound
3) Spine radiographs
(Basically screen for VACTERL)
EA ± TEF Operative repair depends on:
The gap between esophageal ends (on X-Ray)
If the gap between esophageal ends (on xray) is < 2 vertebrae, how should you manage it?
Primary anastomosis
If the gap between esophageal ends (on xray) is 2-6 vertebrae, how should you manage it?
Gastrostomy
+
Delayed primary anastomosis
If the gap between esophageal ends (on xray) is > 6 vertebrae, how should you manage it?
Gastrostomy
+
Esophagostomy
+
Esophageal replacement later on
Which is better for EA ± TEF: Open surgery or MIS?
MIS
Which is more difficult for EA ± TEF: Open surgery or MIS?
MIS
What are the complications of surgical repair of EA ± TEF?
1) Anastomotic Leaks
2) Anastomotic Stricture
3) Recurrent Tracheoesophageal Fistula
4) Tracheomalacia
5) Disordered Peristalsis → GERD → ?! Esophageal Cancer
6) Vocal Cord Dysfunction
7) Respiratory Morbidity
8) Thoracotomy-Related Morbidity
