Esophageal atresia is one of the challenging problems to pediatric surgeons. It needs a team work approach and it is an epitome of modern surgery

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Esophageal Atresia- Epitome
Of Modern Surgery
L/O/G/O
Dr.B.SELVARAJ

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Dr.B.SELVARAJ MS;Mch;FICS;
• NEONATAL & PEDIATRIC SURGEON
• ASSOCIATE PROFESSOR
• MELAKA MANIPAL MEDICAL COLLEGE
• MELAKA- 75150
• MALAYSIA

5. Esophageal Atresia- Epitome of
Modern surgery
Objectives
Recognise various conditions
Make early& accurate diagnosis
Prompt Life Saving treatment
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Immediate 4 surgical referral
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“Please exercise the greatest gentleness with my
diminutive tissues and try to correct the
deformity at first operation; give me blood and
proper amount of fluid and electrolytes; add
plenty of oxygen to anesthesia, and I will show
you that I can tolerate a terrific amount of
surgery. You will be surprised at the speed of my
recovery, and I shall be grateful to you”
--Dr. Willis Potts
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7. Neonatal Respiratory NNNeeeooonnnaaatttaaalll RRReeessspppiiirrraaatttooorrryyy DDDDiiiissssttttrrrreeeessssssss—
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B
Causes
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C
D
Esophageal A
Atresia
Diaphragmatic Hernia
Congenital
Lobar
Emphysema
Posterior
Choanal
Atresia
Pierre
Robin
Sequence
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8. Embryology Of Esophageal Atresia
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Challenging&
Fascinating Problem
Team Work
Approach
VACTERL
Anomaly
Post op Ventilator
Care
Incidence 1 in 3500
livebirths
Epitome of Modern Surgery
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Vertebral
Anorectal
Cardiac- commonest
Tracheo
Esophageal Fistula
Renal
Limb
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Clinical
Features
Drooling of saliva
Maternal Polyhydramnios
Inability to pass NGT
into Stomach
In atresia with TEF Aspiration
of gastric contents
Chemical Pneumonitis
Feeding Cough,
choking
Cyanosis
In pure atresia
Gasless Abdomen
Scaphoid Abd
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14. Physiological Effect of Distal TEF
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• 1. Hyaline membrane disease may
necessitate higher ventilator pressures,
which encourage air to pass through the
distal fistula.
• 2. A distended abdomen elevates and
splints the diaphragm.
• 3. Gastric distension may result in
gastric rupture and pneumoperitoneum.
• 4. Passage of air through a distal
tracheoesophageal fistula diminishes the
effective tidal volume.
(B) 1. Aspiration of gastric juices leads to
soiling of the lungs and pneumonia
• 2. Gastroesophageal reflux
• 3. Direction of gastric fluid proximally
through distal fistula.
• 4. Overflow of secretions or inadvertent
feeding may contribute to aspiration and
contamination of the airway.

15. Esophageal Atresia
Imaging Studies
AXR CXRCurledup NGT in blind upper pouch
CXRAtelectasisPneumonia
AXRGasless in pure Atresia
Antenatal MRI of Fetus
Imaging
S Studies
USG Abdto R/O Urogenital anomaly
Echo to R/O cardiac
anomalyRt Aortic
arch
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Esophageal Atresia
Antenatal MRI
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17. Esophageal Atresia
Clinical Diagnosis
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• . (A) Diagnosis of
esophageal atresia is
confirmed when a 10-
gauge (French)
catheter cannot be
passed beyond 10 cm
from the gums. (B) A
smaller-caliber tube is
not used because it
may curl up in the
upper esophageal
segment, giving a false
impression of
esophageal atresia.

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Esophageal Atresia
CXR
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19. Esophageal Atresia With
TE Fistula- Bronchoscopy
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Rt Bronchus
TE Fistula

20. Esophageal Atresia
Pre op Management
NPO
Pre op Proximal pouch
Decompression
S I V Antibiotics
If for staged repair
Do Gastrostomy
Head up position
In pure atresia
Stretch proximal pouch
daily
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21. Esophageal Atresia
Pre op Management
NPO
Pre op Proximal pouch
Decompression
S I V Antibiotics
If for staged repair
Do Gastrostomy
Head up position
In pure atresia
Stretch proximal pouch
daily
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22. Esophageal Atresia
Waterston’s Risk Categories
/Birth weight 2.5 Kgs
/No Anomalies
/No Pneumonitis
/Primary Repair100%survival
/Birth weight 1.8 to 2.5 Kgs
/Non life threatening anomalies
/Mild Pneumonitis
/Delayed Primary Repair80%survival
/Birth weight 1.8 Kgs
/Life threatening anomalies
/Severe Pneumonitis
/Staged Repair40%survival
Risk
Categories
Category
A
Category B
Category C
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23. Esophageal Atresia
Operative Management
1
2
3
Lanman’s Rt posterolateral retropleural
thoracotomy
Ligation division of Azygos vein
Disconnect TEF; Repair tracheal defect
4 Liberally mobilise the upper pouch for tension
free anastomosis
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24. Esophageal Atresia
Operative Management
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7
In wide gapLivaditi’s circular myotomies
Never mobilise distal pouch much
Extra pleural drain
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Transanastomotic feeding tube for early gavage
feeding

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Esophageal Atresia
Operative Management
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26. Normal Mediastinum- Rt side
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27. Esophageal Atresia
Immediate Primary Repair
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Esophageal Atresia
Immediate Primary Repair

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Esophageal Atresia
VATS Repair
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31. Esophageal atresia
Post op Management in NICU
Otherwise exubate in 1st POD
Regular chest PhysioNasopharyngeal
suction
Feeding through transanastomotic feeding
Tube from 2nd POD
Gastrograffin swallow on 7th POD; If no leakoral
Feeding remove chest drain
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Electively paralysemechanically ventilate
For 3 to 5 days in tension anastomosis

32. Esophageal Atresia
Complications
LATE
Tracheomalacia
GE Reflux
EARLY
Anastomotic Leakage
Anastomotic Stricture
Recurrent TEF Esophageal Dysmotility
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33. Esophageal Atresia
TE Fistula Recap
Clinical
Features
Complica
tions
Operation
EA
TEF
Preop
Trt
•VACTERL
•Maternal Poly Hydramnios
•Drooling of saliva in baby
•Inability to pass NGT into stomach
•NPO
Associ
Anomaly
Imaging
CXR
•Headup position
•IV Antibiotics
•Upper pouch suction
•Curledup NGT in blind
upper pouch
•Echo to R/O cardiac
Anomaly
• USG Abd to R/O
Urogenital anomaly
•Anastomotic leak
•Anastomotic stricture
•Tracheomalacia
•GE Reflux
•Immediate primary
Repair
•Delayed primary
Repair
•Staged Repair
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