Definition
The restoration of esophageal continuity (esophageal atresia) and the repair of an abnormal connection between the trachea and the esophagus (tracheoesophageal fistula).
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
- 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.
- The mediastinal pleura are incised and the lower esophagus is exposed and mobilized.
- The tracheoesophageal fistula is transected, closed, and tested for air leaks by filling the chest with a small amount if saline.
- 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.
- A small gastrostomy feeding tube may be passed transnasally into the esophagus, across the anastomotic site, into the stomach for postoperative feeding.
- A chest tube is positioned, and the incision is closed.
- 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
- When transferring a patient with a chest tube, keep the closed drainage system below body level.
- Use strict aseptic technique during the procedure.
- During the procedure, instruments used must be isolated in a basin.
