Esophageal Atresia

Esophageal atresia (EA) with distal tracheo-esophageal fistula (TEF) is the most common
congenital anomaly of the esophagus, followed by EA without TEF also known as pure
esophageal atresia and pure TEF.

Incidence is one in every 2500 live births.

Development - The trachea and esophagus begin as a ventral diverticulum of the foregut
during the third intrauterine week of life. A proliferation of endodermal cells appears on
the lateral aspect of this growing diverticulum. These cell masses will divide the foregut
into trachea and esophageal tubes.

There is interruption of this normal event

during tracheal growth atresia of the esophagus results because of fistulous

fixation of the esophagus to the trachea

. Polyhydramnios is seen in pure EA.

Newbors- EA causes
excessive salivation,
choking,
coughing,
regurgitation with first feed
inability to pass a feeding tube into the stomach.

Management - X ray with tube in situ – shows obstruction

Correct dehydration,

acid-base disturbances,

respiratory distress

decompress proximal esophageal pouch

Evaluate for associated conditions such as VACTERL association.

-Vertebral anomalies i.e. hemivertebrae, spina bifida

-Anal malformations i.e. imperforate anus
-Cardiac malformations i.e. VSD, ASD, Tetralogy Fallot
-Tracheo-Esophageal fistula (must be one of the associated conditions)
-Renal deformities i.e. absent kidney, hypospadia, etc.
-Limb dysplasia
Early surgical repair (transpleural or extrapleural) is undertaken for those babies with
adequate arterial blood gases, adequate weight (>1200 gm) and no significant associated
anomalies.

Delayed repair (gastrostomy first) for all other patients.

Repair
thoracotomy,
closure of TEF
primary anastomosis.

Esophagogram is done 7-10 days after repair.

Prognosis depends on –
birth weight,
severity of pulmonary dysfuntion,
presence of major congenital cardiac disease.

Complications after surgery:

anastomotic leak,
stricture,
gastroesophageal reflux,
tracheomalacia
recurrent TEF.

most common complications after surgery: are in order of frequency: stricture, leakage
and recurrent TEF.