Surgery is the only treatment for TEF and EA. Most babies with the conditions will have surgery soon after they are born. Some babies who have other, associated problems may need to wait a short time before having surgery. Babies can be transferred to Seattle Children's Level IV NICU for care after surgery. Seattle Children’s is the first hospital in Washington to have a Level IV NICU – the highest level of care.
The type of surgery babies have depends on their condition. Your baby's surgeon will talk with you about this once we know your baby’s needs. In many cases, surgeons correct the problem with one operation. Sometimes doctors need to correct the problem in stages. Your baby's surgeon will go over the possibilities with you.
Surgery for Tracheoesophageal Fistula and Esophageal Atresia
No matter what type of operation your child has, we will give your child medicine to make them sleep without pain during the surgery (general anesthesia).
Surgery for TEF and EA combined
The surgeon will make a cut, or incision, in your child’s chest, usually on the right side. Then, the surgeon will cut through the abnormal channel between the windpipe and esophagus and sew it closed. Next, If the two ends of the esophagus are close enough to each other, the surgeon will repair the tube by sewing the ends together.
If the ends of the esophagus are too far apart to attach safely, the surgeon will repair the abnormal channel, but not the esophagus. The surgeon will place a feeding tube in your child’s stomach. This is called a gastrostomy (pronounced gas-STRAH-stuh-mee). See the section below for more about this operation.
Surgery for TEF/EA usually takes about 2 to 3 hours.
When your baby leaves the operating room, they will be using a machine to help with breathing (ventilator). They may need to use the ventilator for several days after surgery, until they have healed enough to breathe on their own. We will care for your baby in our Neonatal Intensive Care Unit (NICU) both before and after the surgery.
Surgery for EA only
The baby probably will not have surgery right away. Instead, doctors wait until the baby grows a little larger. This way, your baby's esophagus will be longer and easier to sew together. In the meantime, your baby will need a gastrostomy to get nutrition.
Surgery for TEF only
The repair can usually be done through a small incision in the baby’s neck. The surgeon will find the abnormal channel, divide it, and sew the trachea and esophagus closed.
The surgeon makes an opening through the wall of your baby's belly and places a tube into the stomach. This provides a safe way to give your baby nutrition until they can feed by mouth. It also lets doctors give your baby medicine, if needed. The surgery team will teach you how to take care of the tube and the skin around it, and how to feed your child through the gastrostomy.
The surgeon will take out the gastrostomy after your baby has surgery to repair the esophagus and has had time to heal. This usually takes at least several months.
After Surgery for Tracheoesophageal Fistula and Esophageal Atresia
After surgery, we give your child pain medicine to make them comfortable.
Your baby will not be able to eat by mouth at first. They will get fluids and nutrition through an IV (intravenous) line, a tube that goes into a vein. Many babies will need a special IV called a PICC line.
If your baby had surgery to connect the esophagus, after about a week we will ask them to swallow a liquid called barium and take X-rays (barium swallow test.) This helps doctors check for leaks at the spot where the esophagus was repaired. If there is no leak, your baby can start feeding by mouth.
Most babies start feeding slowly and may not be able to take all the nutrition they need by mouth for several days or weeks. Some babies need supplemental feedings given by a small feeding tube passed through the nose, down the esophagus and into the stomach.
The time babies need to stay in the hospital after surgery for TEF and EA varies. If your baby is healthy and the repair was simple, they may need to stay for a minimum of two weeks. If your baby has other health problems, an esophageal atresia with no fistula, or if the repair was delayed, your baby may need to be in the hospital for weeks to months.
About one to three weeks after discharge from the hospital, your child will need to see the surgeon for a follow-up visit. The surgeon will make sure the incision is healing and your child is recovering, gaining weight and growing properly. Your baby may need frequent follow-up appointments to make sure everything is working well.
The most common long-term problem for babies with TEF/EA is a condition called gastroesophageal reflux. We usually can treat this with medicine.
As they grow older, children with TEF/EA usually can eat normally. They probably will need to eat more slowly and chew more thoroughly than people who did not have TEF/EA.