Chromosomal and Genetic Conditions

Tracheoesophageal Fistula and Esophageal Atresia Treatment

Treatment

TEF and EA affect only about 1 in 4,000 children a year, but Seattle Children’s sees about 10 to 15 children with these conditions each year. Our doctors and surgeons are very experienced at repairing this condition and helping your family through treatment. We are the only hospital in the region where patients with TEF/EA can get care from a team of specialists with expertise in all the problems these babies may have.

Surgery for Tracheoesophageal Fistula and Esophageal Atresia

Most babies with TEF and EA 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.

The type of surgery depends on the baby’s condition. In many cases, surgeons correct the problem with one surgery. Other times, doctors need to correct the condition in stages. Your baby’s surgeon will go over the possibilities and options with you.

Your child will need anesthesia for the surgery. Our pediatric anesthesiologists are specially trained to give your child medicine to make them safely sleep without pain during their surgery.

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 find and cut through the abnormal channel (fistula) between the windpipe and esophagus and sew it closed. 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 fistula connected to the trachea (windpipe), 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). The surgery to repair the esophagus will be done later. Your surgeon will discuss the options with you.

Surgery for TEF/EA usually takes 2 to 3 hours.

When your baby leaves the operating room, they will probably need a machine to temporarily help them breathe (ventilator). Your baby may need to use the ventilator for several days after surgery, until they have recovered 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.

Seattle Children’s is the first hospital in Washington to have a Level IV NICU — the highest level of care for your baby.

Surgery for TEF only

If a baby has TEF but not EA, doctors can usually repair it through a small incision in the baby’s neck. The surgeon will find the fistula, divide it and sew the trachea and esophagus closed.

Surgery for EA only

If a baby has EA but not TEF, doctors may wait until the baby grows larger to attempt to sew the esophagus together. This can let the esophagus grow and bring the two ends closer together.

Sometimes, the two ends remain far apart. Several techniques can be used to repair or even replace the esophagus. Your surgeon will discuss these options with you.

Your baby will need a gastrostomy to get nutrition until they have surgery to repair the esophagus.

Gastrostomy

A gastrostomy is a safe way to give your baby nutrition until they can eat by mouth. A surgeon makes an opening through the wall of your baby’s belly and places a tube into the stomach. Your baby receives nutrients through this tube. This tube also lets doctors give your baby medicine if needed. We will teach you how to take care of the tube and the skin around it, and how to feed your child through the gastrostomy.

Your surgeon will take out the gastrostomy after your baby has surgery to repair the esophagus. Some babies will need the gastrostomy tube for several months or even longer. This is because they need to learn to swallow with their new esophagus.

After Surgery for Tracheoesophageal Fistula and Esophageal Atresia

After surgery, we will give your child pain medicine to make them comfortable. Your baby will get fluids and nutrition through an IV (intravenous) line, a tube that goes into a vein.

About a week after your baby’s surgery, we will have your child 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 may be able to start feeding by mouth.

Most babies start feeding slowly. They may not be able to get the nutrition they need by mouth for several days or weeks. Some babies need supplemental feedings through a feeding tube passed through the nose 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 is simple, they may need to stay for a little more than 2 weeks. Your baby may need to stay in the hospital for several more weeks or months if they have other health problems, if they have an esophageal atresia with no fistula or if doctors have to wait to do surgery.

About 1 to 3 weeks after your baby leaves the hospital, they 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 will need follow-up appointments to make sure everything is working well. We continue to monitor and support your child as they grow.

Your child’s follow-up care will be coordinated by our Surgery Pulmonary Follow-Up (SPF) Clinic.

As children with TEF/EA grow, they can eat fairly normally but may need to eat more slowly and chew more than people who did not have TEF/EA.

The most common long-term problem for babies with TEF/EA is a condition called gastroesophageal reflux. We usually can treat this with medicine. Children with TEF/EA also might get more colds and other respiratory illnesses than other children.

Contact Us

To learn more about treatment for TEF/EA at Seattle Children’s, call our General and Thoracic Surgery Department at 206-987-2794 x4.