It is always important to know what is going on in the world of COPD/Asthma, hence a new weekly (at the minimum) posting of ‘Notes to Know about COPD/Asthma’ – because those of us battling the issue should always be up to date on what is going on, and that includes both the positives and the negatives of the COPD/Asthma life.

Presented here is a copy of an article posted on medicineplus.gov that discusses infants being born with trachea and esophagus problems – in particular having an esophagus that does not extend to the stomach as it should and in the case of this writer, my esophagus was connected to my trachea or windpipe.

Special note – this article is shared because the writer of these postings was born with this particular birth defect and personally has concluded that my lung problems began from birth when they tried to feed me and everything went straight into my lungs, which in turn (in my opinion) had to have caused some type of damage at that time.

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Tracheoesophageal fistula and esophageal atresia repair

Tracheoesophageal fistula and esophageal atresia repair is surgery to repair two birth defects in the esophagus and trachea.

Description

The esophagus is the tube that carries food from the mouth to the stomach. The trachea, or windpipe, is the tube that carries air into and out of the lungs.

These defects usually occur together:

Esophageal atresia (EA) occurs when the upper part of the esophagus does not connect with the lower esophagus and stomach.

Tracheoesophageal fistula (TEF) is an abnormal connection between the upper part of the esophagus and the trachea or windpipe.

This surgery is almost always done soon after birth. Both defects can usually be repaired at the same time.

Briefly, the surgery takes place this way:

Medicine (anesthesia) is given so that the baby is in a deep sleep and pain-free during surgery.

The surgeon makes a cut on the side of the chest between the ribs.

The fistula between the esophagus and windpipe is closed.

Then the upper and lower portions of the esophagus are sewn together.

If the two parts of the esophagus are too far apart, then:

Only the fistula is repaired during the first surgery.

A gastrostomy tube (a tube that goes through the skin into the stomach) may be placed to give your child nutrition.

Your child will have another surgery later to repair the esophagus.

Sometimes the surgeon will wait 2 to 4 months before doing the surgery. Waiting allows your baby to grow or have other problems treated. If your child’s surgery is delayed:

A gastrostomy tube (G-tube) will be placed through the abdominal wall into the stomach. Numbing medicines (local anesthesia) will be used so that the baby does not feel pain.

At the same time the tube is placed, the doctor may widen the baby’s esophagus with a special instrument called a dilator. This will make the future surgery easier.

Why the Procedure is Performed

Tracheoesophageal fistula and esophageal atresia are life-threatening problems. They need to be treated right away. If these problems are not treated:

Your child may breathe saliva and fluids from the stomach into the lungs. This is called aspiration. It can cause choking and pneumonia (lung infection).

Your child cannot swallow and digest food safely or at all.

Risks of anesthesia and surgery in general include:

Reactions to medicines

Breathing problems

Bleeding, blood clots, or infection

Risks of this surgery include:

Collapsed lung (pneumothorax)

Food leakage from the area that is repaired

Low body temperature (hypothermia)

Narrowing of the repaired organs

Re-opening of the fistula

Before the Procedure

Your baby will be admitted to the neonatal intensive care unit (NICU) as soon as the doctors diagnose either of these problems.

Your baby will receive nutrition by vein (intravenous, or IV) and may also be on a breathing machine (ventilator). The care team may use suction to keep fluids from going into the lungs.

Some infants who are premature, have a low birth weight, or have other birth defects beside TEF and/or EA may not be able to have surgery until they grow larger or until other problems have been treated or have gone away.

After the Procedure

After surgery, your child will be cared for in the hospital’s NICU.

Additional treatments after surgery usually include:

Antibiotics as needed, to prevent infection

Breathing machine (ventilator)

Chest tube (a tube through the skin into the chest wall) to drain fluids from the space between the outside of the lung and the inside of the chest cavity.

Intravenous (IV) fluids, including nutrition

Oxygen

Pain medicines as needed

If both the TEF and EA are repaired:

A tube is placed through the nose into the stomach (nasogastric tube) during the surgery.

Feedings are usually started through this tube a few days after surgery.

Feedings by mouth are started slowly. The baby may need feeding therapy.

If only the TEF is repaired, a G-tube is used for feedings until the atresia can be repaired.

While your baby is in the hospital, the care team will show you how to use and replace the G-tube. You may also be sent home with an extra G-tube. The hospital staff will inform a home health supply company of your equipment needs.

How long your infant stays in the hospital depends on the type of surgery your child has and whether there are other problems in addition to the TEF and EA. You will be able to bring your baby home once he or she is taking feedings by mouth or gastrostomy tube and is gaining weight.

Outlook (Prognosis)

Surgery can usually repair a TEF and EA. Once healing from the surgery is complete, your child may have these problems:

The part of the esophagus that was repaired may become narrower. Your child may need to have more surgery to treat this.

Your child may have heartburn or gastroesophageal reflux (GERD). This occurs when acid from the stomach goes up into the esophagus. GERD may cause breathing problems.

During infancy and early childhood, many children will have problems with breathing, growth, and feeding, and will need to continue seeing both their primary care provider and specialists.

Babies with TEF and EA who also have defects of other organs, most commonly the heart, may have long-term health problems.

Alternative Names

TEF repair; Esophageal atresia repair

References:

Madanick R, Orlando RC. Developmental anomalies of the esophagus. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 42.

Rothenberg SS. Esophageal atresia and tracheoesophageal fistula malformations. In: Holcomb GW, Murphy JP, Ostlie DJ, eds. Ashcraft’s Pediatric Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 27.

Review Date 11/3/2015

Updated by: Kimberly G Lee, MD, MSc, IBCLC, Associate Professor of Pediatrics, Division of Neonatology, Medical University of South Carolina, Charleston, SC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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‘Notes to Know about COPD/Asthma’ will feature writings from medical folks and caretakers who share insights into the world of what may be going on in the world of COPD/Asthma.  ‘Notes to Know about COPD/Asthma’ will be found at either wheezingaway.com or within the Facebook page, COPD Travels.

Remember – ‘a person without good breathing, is a person without a good life’, so let’s do what we can, to learn what we can, to improve what we can.

I bid to all – smiles, prayers, blessings and steady breathing – Mr. William.

(Copyright@2017, CrossDove Writer through wheezingaway.com – no part of this write may be used or copied without written permission.)

NOTES: Sometimes we share what may seem like medical information, but we are only giving descriptions and highlights of various aspects of having COPD and/or asthma and no way do we ever want our information to be considered medical treatment type of information, always consult your physician for more, clearer and more medical founded information.