PAEDIATRIC SURGERY

1. SOMNATH MAITY
INTERN

2. It is an abnormal connection between the
trachea and the esophagus.

3.  1 in 3500 births
 Male predominance.
 common in prematurity.
 50% with associated anomalies.
 Cardiac anomalies.( 14.8 – 24 %)

4.  First pregnancy
 age of mother < 20 years
 Elderly mothers.
 Multiple births.
 Trisomy 18 ( Edward’s Syndrome)

5. Upper part of esophagus develops from retro-
pharyngeal segment of primitive gut and the
lower part from the first part.
At 4-5 weeks of gestation, a laryngo-tracheal
groove is formed and divides the foregut into
two longitudinal furrows.
Respiratory tract is then separated from the
esophagus.

6. Defective separation due to deviated or
incomplete septum or due incomplete fusion
of tracheal folds result in fistula formation
between the trachea and the esophagus.

8.  Excessive salivation and constant drooling of
saliva from the mouth.
 Violent response during feeding : (3 C s)
• Coughing
• Chocking
• Cyanosis
 Fluid returns through the mouth and nostrils.
 Frothy salivation.
 Abdominal distension in types C, D, E.
 Aspiration Pneumonia.

10. 1. Prenatal
2. Postnatal
PRENATAL :
a) USG : reveals polyhydramnios, absence of
fluid filled stomach, a small abdomen,
and a distended esophageal pouch.
b) Fetal MRI: Confirmatory.

12. Postnatal:
• X-Rays: done using radio opaque catheter in
the esophagus to check for obstructions.
• Bronchoscopy: shows fistula between trachea
and esophagus.
• Inability to pass nasogastric tube due to
resistance.

16. PREOPERATIVE MEASURES
 Attention to the respiratory status of the infant.
 Positioning of infant.
 Decompression of the upper pouch
 Appropriate timing of surgery
 Passing of a nasogastric tube.
 Presence of other associated anomalies like
congenital cardiac disease.
 NPM, TPN.
 Upper pouch suction.
 IV antibiotics.
 IV fluids.

17.  Surgery :- Definitive Treatment
 Timothy Holmes(1869) first suggested
surgical anastomosis.
 Charles Steelle (1888) first surgical attempt.
 Esophago-esophagostomy : Thoracotomy
Thoracoscopy

19. Staging Surgery
 1st Stage: TEF ligated and gastrostomy is
done to reduce the risk of reflux to provide
feeding.
 2nd Stage: Both proximal and distal segments
are anastomosed. And if the gap is too large
then a segment of it is used for
reconstruction of the esophagus at 18-24
months.

20.  IV Fluids continuing.
 Provide oxygen
 Feeding orally or through Gastrostomy.
 Analgesics if required.

21.  Tracheomalacia.
 Dysphagia.
 Esophageal strictures.
 Respiratory Distress.
 GERD.

22.  Aspiration pnemonitis with
pneumonia .
 Esophageal diverticula.
 Esophageal strictures.
 Esophagitis.
 GERD.