Article

Surgical Treatment of Esophageal Atresia and Tracheo-Esophageal Fistula in the Infant

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Abstract

ESOPHAGEAL atresia and the associated fistulas between the tracheo-bronchial tree and the esophagus form a highly significant group of congenital anomalies that is regularly seen in hospitals that have many obstetric and newborn patients. Twenty years ago these lesions were considered interesting but hopeless anatomic curiosities; now they are significant because they are curable. Untreated, this group of anomalies is lethal, whereas successful surgery results in a normally functioning upper gastrointestinal tract. Therefore, it is vitally important that the diagnosis be promptly made. At the present time the two commonest reasons for failure of treatment of this anomaly are the presence of other major anomalies and associated prematurity.

Anatomic Considerations

The embryologic aspects of esophageal atresia will not be discussed here, suffice it to say that interruption of esophageal continuity and fistulous communication between the esophagus and the tracheo-bronchial tree are commonly associated, and all of the theoretically possible combinations of esophageal discontinuity and fistula have been seen clinically. The fistula may extend from an upper blind esophageal pouch to the trachea, from the lower end of the esophagus to the trachea, or both esophageal ends may communicate with the respiratory tract. Esophageal discontinuity varies in length and there may be no fistula to the trachea. Conversely, a tracheo-esophageal fistula may be present without an interruption in esophageal continuity; this is the so-called “H” fistula.

In practice, it is important to know that more than 90 per cent of all patients have one basic form of this anomaly: namely, a. . .


 

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