Tracheoesophageal Fistula Repair

Definition

The restoration of esophageal continuity (esophageal atresia) and the repair of an abnormal connection between the trachea and the esophagus (tracheoesophageal fistula).

RepairOfTracheoesophagealFistula

Discussion
  • Esophageal atresia, which may or may not be associated with fistula, may develop during the first 3 to 6 weeks of life. The most common fistula occurs at the upper segment of the esophagus, ending in a blind pouch with the lower segment of the esophagus connected by a fistula to the trachea.
  • Prompt surgical intervention may prevent respiratory and eating difficulties. It may be necessary to perform a gastrostomy first, to decompress the air-distended stomach.
Positioning
  • Lateral; right side up; a small pillow is placed between the legs, left leg is straight, right is flexed.
Packs/ Drapes
  • Pediatric laparotomy sheet
  • Plastic adherent sheet
Instrumentation
  • Pediatric laparotomy tray
  • Pediatric thoracotomy tray
  • Hemoclip
  • Small bone cutter
Supplies/ Equipment
  • Thermal blanket
  • Positioning aids
  • Basin set
  • Suction
  • Scale (to weigh sponges)
  • Blades
  • Needle counter
  • Vessel loops
  • Infant chest drainage unit
  • Chest tube
  • Hemoclips
  • Bone wax
  • Solutions
  • Sutures
Procedure
  1. If a transpleural approach is used, a right posterolateral incision is made over the fifth rib and the pleura are entered via the fourth intercostal space.
  2. The mediastinal pleura are incised and the lower esophagus is exposed and mobilized.
  3. The tracheoesophageal fistula is transected, closed, and tested for air leaks by filling the chest with a small amount if saline.
  4. Depending on the diameter and thickness of the upper and lower muscular wall segments, esophageal continuity is established by one of several one-or-two layer technique.
  5. A small gastrostomy feeding tube may be passed transnasally into the esophagus, across the anastomotic site, into the stomach for postoperative feeding.
  6. A chest tube is positioned, and the incision is closed.
  7. If the chest is entered retropleurally, a chest tube is not required, but a small Penrose drain may be inserted close to the anastomosis and brought out through the lateral corner of the wound.
Perioperative Nursing Considerations
  1. When transferring a patient with a chest tube, keep the closed drainage system below body level.
  2. Use strict aseptic technique during the procedure.
  3. During the procedure, instruments used must be isolated in a basin.
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