# Esophageal Atresia and Tracheoesophageal Fistula — GCMD Library living collection

Updated: n/a · 17 episodes · 37 cited statements

## Episodes
### Thoracoscopic repair
- [Thoracoscopic Esophageal Atresia Repair Tips & Tricks: Update Course 2018](https://qa.library.globalcastmd.com/watch/thoracoscopic-esophageal-atresia-repair-tips-tricks-update-course-2018-355) — video · [machine version](https://qa.library.globalcastmd.com/watch/thoracoscopic-esophageal-atresia-repair-tips-tricks-update-course-2018-355.md)
- [Rothenberg Thoracoscopic Technique Video: EA/TEF](https://qa.library.globalcastmd.com/watch/rothenberg-thoracoscopic-technique-video-ea-tef-1074) — video · [machine version](https://qa.library.globalcastmd.com/watch/rothenberg-thoracoscopic-technique-video-ea-tef-1074.md)
- [Tips and Tricks: EA & TEF](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075) — video · 9:27 · [machine version](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075.md)
- [JRS TEF](https://qa.library.globalcastmd.com/watch/jrs-tef-11923) — video · 19:36 · [machine version](https://qa.library.globalcastmd.com/watch/jrs-tef-11923.md)
- [JRS TEF SHORT](https://qa.library.globalcastmd.com/watch/jrs-tef-short-11922) — video · 2:05 · [machine version](https://qa.library.globalcastmd.com/watch/jrs-tef-short-11922.md)
- [TEF 2 min HD](https://qa.library.globalcastmd.com/watch/tef-2-min-hd-11967) — video · [machine version](https://qa.library.globalcastmd.com/watch/tef-2-min-hd-11967.md)
- [QUAD #10 Pt.1: History of Thoracoscopic Repair of Esophageal Atresia (EA) & Tracheoesophageal Fistula (TEF) with Dr. Steve Rothenberg](https://qa.library.globalcastmd.com/watch/quad-10-pt-1-history-of-thoracoscopic-repair-of-esophageal-atresia-tracheoesopha-8702) — video · 6:27 · [machine version](https://qa.library.globalcastmd.com/watch/quad-10-pt-1-history-of-thoracoscopic-repair-of-esophageal-atresia-tracheoesopha-8702.md)
- [QUAD #10 Pt.2: Surgical Technique for Thoracoscopic Repair of Tracheoesophageal Fistula (TEF) with Dr. Steve Rothenberg](https://qa.library.globalcastmd.com/watch/quad-10-pt-2-surgical-technique-for-thoracoscopic-repair-of-tracheoesophageal-fi-8704) — video · [machine version](https://qa.library.globalcastmd.com/watch/quad-10-pt-2-surgical-technique-for-thoracoscopic-repair-of-tracheoesophageal-fi-8704.md)
- [QUAD #10 Pt.3: Advantages of Thoracoscopic Repair of Esophageal Atresia with Dr. Steve Rothenberg](https://qa.library.globalcastmd.com/watch/quad-10-pt-3-advantages-of-thoracoscopic-repair-of-esophageal-atresia-with-dr-st-8703) — video · [machine version](https://qa.library.globalcastmd.com/watch/quad-10-pt-3-advantages-of-thoracoscopic-repair-of-esophageal-atresia-with-dr-st-8703.md)
- [TEF 2015](https://qa.library.globalcastmd.com/video/11968) — article · [machine version](https://qa.library.globalcastmd.com/video/11968.md)
- [TEF akron 2018](https://qa.library.globalcastmd.com/video/11969) — article · [machine version](https://qa.library.globalcastmd.com/video/11969.md)

### Long-gap atresia
- [Long Gap Esophageal Atresia – How I Do It: Update Course 2018](https://qa.library.globalcastmd.com/watch/long-gap-esophageal-atresia-how-i-do-it-update-course-2018-354) — video · [machine version](https://qa.library.globalcastmd.com/watch/long-gap-esophageal-atresia-how-i-do-it-update-course-2018-354.md)
- [Long Gap Technique Videos: EA & TEF](https://qa.library.globalcastmd.com/watch/long-gap-technique-videos-ea-tef-1078) — video · [machine version](https://qa.library.globalcastmd.com/watch/long-gap-technique-videos-ea-tef-1078.md)
- [long gap medtronic](https://qa.library.globalcastmd.com/watch/long-gap-medtronic-11987) — video · [machine version](https://qa.library.globalcastmd.com/watch/long-gap-medtronic-11987.md)
- [Update Course 2021: MAGNET THERAPY FOR ESOPHAGEAL ATRESIA](https://qa.library.globalcastmd.com/watch/update-course-2021-magnet-therapy-for-esophageal-atresia-5416) — video · [machine version](https://qa.library.globalcastmd.com/watch/update-course-2021-magnet-therapy-for-esophageal-atresia-5416.md)

### H-type and recurrent fistula
- [VATS H-Type Fistula Repair - Technique](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749) — video · 4:36 · [machine version](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=0) Case presentation and patient positioning (Ep 16)
- [1:30](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=90) Initial dissection and plane development (Ep 16)
- [3:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=180) Fistula mobilization and stapler division (Ep 16)
- [4:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=240) Closure and postoperative result (Ep 16)
- [0:00](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=0) Feeding tube placement and dissection techniques (Ep 3)
- [1:35](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=95) Avoiding membranous tracheal injury and suture technique (Ep 3)
- [3:19](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=199) Managing tension and preventing recurrent fistula (Ep 3)
- [5:52](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=352) Long-gap EA management and azygos vein considerations (Ep 3)
- [7:50](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=470) Fistula division technique and distal esophageal management (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- For thoracoscopic H-type fistula repair, the patient is placed in modified lateral decubitus position rolled prone approximately 45 degrees. (clinical) [Ep 16 · 1:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=60)
- Three ports were used: one 4 mm port (later advanced to 5 mm) and two 3 mm ports. (clinical) [Ep 16 · 1:30](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=90)
- A 4 mm 30-degree lens was used for the procedure and placed behind the tip of the scapula. (clinical) [Ep 16 · 1:45](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=105)
- The procedure starts in the apex using a 3 mm vessel sealer for dissection and to open the pleura. (clinical) [Ep 16 · 2:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=120)
- Developing a plane between esophagus and trachea below the level of the fistula is an important maneuver to help safely separate the two structures before encountering the very adherent area. (clinical) [Ep 16 · 2:30](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=150)
- Placing a catheter across the H-type fistula can occasionally be helpful for identification, though it was not used in this case. (opinion) [Ep 16 · 3:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=180)
- A 3 mm hook cautery was used to pull on fibers and separate them away from critical structures. (clinical) [Ep 16 · 3:15](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=195)
- Dissection is carried out above the fistula so that a retro-fistula plane can be developed. (clinical) [Ep 16 · 3:30](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=210)
- An instrument is passed around behind the fistula, taking care not to injure the esophagus or membranous portion of the trachea. (clinical) [Ep 16 · 3:45](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=225)
- A 2-0 silk suture is passed around the fistula to help with retraction. (clinical) [Ep 16 · 4:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=240)
- Previously, the technique involved dividing the fistula and then oversewing the two ends. (clinical) [Ep 16 · 4:15](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=255)
- In this case, with the child large enough and availability of a 5 mm stapler, a decision was made to use the stapler to divide the fistula. (clinical) [Ep 16 · 4:30](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=270)
- Care must be taken to ensure the recurrent laryngeal nerve and other important structures are not within the field of dissection. (clinical) [Ep 16 · 4:45](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=285)
- The lower port in the posterior axillary line was enlarged to 5 mm to accommodate the stapler. (clinical) [Ep 16 · 5:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=300)
- A single application of the 5 mm stapler divided the fistula, placing two rows of staples on either side. (clinical) [Ep 16 · 5:15](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=315)
- Apical fat is taken and sewn down to cover the esophageal end of the staple line to help separate the two staple lines and prevent recurrent fistulization. (clinical) [Ep 16 · 5:30](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=330)
- The pleura is closed over the divided fistula so that any leak would remain contained. (clinical) [Ep 16 · 5:45](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=345)
- The lung was re-expanded and no chest tube was left. (clinical) [Ep 16 · 6:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=360)
- Spitz uses a 6 French feeding tube (not a Replogle) for feeding in the first few days after esophageal atresia repair. — Spitz (clinical) [Ep 3 · 0:04](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=4)
- Jack leaves a 5 French feeding tube, both for feeding and to protect the back wall during the anastomosis. — Jack (clinical) [Ep 3 · 0:18](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=18)
- Steve uses a 10 French Replogle across the anastomosis. (clinical) [Ep 3 · 0:49](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=49)
- When separating the upper pouch from the membranous trachea, Steve uses blunt and sharp dissection; he only uses cautery if he can clearly see the tissues and knows he is not injuring the membranous trachea. — Steve (clinical) [Ep 3 · 1:10](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=70)
- Surgeons have created holes in the membranous trachea during dissection of the plane between the membranous trachea and the medial wall of the upper pouch, resulting in acquired tracheoesophageal fistula that is very difficult to fix. (clinical) [Ep 3 · 1:35](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=95)
- Cautery should never be used to dissect the upper pouch off the membranous trachea; sharp dissection is the only safe way. (clinical) [Ep 3 · 1:35](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=95)
- For extracorporeal knots on the first couple of stitches, Vicryl should not be used because it is very hard to tie an extracorporeal knot with it. — Steve (clinical) [Ep 3 · 2:19](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=139)
- If tying extracorporeally, PDS should be used because it slides better than Vicryl. — Steve (clinical) [Ep 3 · 2:41](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=161)
- When there is an anastomosis under tension and concern about a leak, it is advisable to get some tissue between the two suture lines to prevent development of a recurrent fistula. (clinical) [Ep 3 · 3:19](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=199)
- A pleural flap or pericardial flap can be used to place vascularized tissue between the two suture lines. (clinical) [Ep 3 · 3:19](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=199)
- In a baby, a thick pleural flap can incorporate some of the muscle of the intercostal spaces and some fat. (clinical) [Ep 3 · 3:19](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=199)
- The thing that causes most recurrent fistulas is a leak; the thing that causes most leaks is too much tension on the anastomosis. (clinical) [Ep 3 · 3:19](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=199)
- For premature infants with a very small upper pouch and a fistula, Steve has ligated the fistula thoracoscopically and, if the baby is doing well, mobilized the upper pouch; if unable to get it together, he places an internal stitch in the upper pouch under tension and returns in 4 to 6 weeks to do the anastomosis. — Steve (clinical) [Ep 3 · 5:52](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=352)
- The advantage of doing the procedure thoracoscopically is that there is no big thoracotomy incision, allowing evaluation and decision-making about whether the anastomosis can be performed. — Steve (clinical) [Ep 3 · 5:52](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=352)
- For premature infants, if only the fistula is ligated (maybe without dissecting so it does not slip back) and waiting 4 to 6 to 8 weeks for spontaneous growth, the anastomosis can be done later. (clinical) [Ep 3 · 6:48](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=408)
- If the azygos vein is ligated, the distal end can be opened and placed over the tracheal or esophageal suture line. — Spitz (clinical) [Ep 3 · 7:50](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=470)
- Jack placed a clip on a fistula in a preemie without dividing it, and 3 weeks later the fistula recurred. — Jack (clinical) [Ep 3 · 8:26](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=506)
- If clipping the fistula, it must be divided; just putting a clip on can lead to recanalization. — Steve (clinical) [Ep 3 · 8:41](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=521)
- When doing just a fistula division or ligation and it is clear the two ends cannot be put together, the distal segment should be tacked up to the vertebral body (prevertebral fascia) to keep it from shrinking down. — Spitz (clinical) [Ep 3 · 8:57](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=537)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- The patient was a 3-month-old infant with multiple medical issues who had recurrent aspiration. — The host summarizing a resource [Ep 16 · 0:00](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=0)
- Upper GI study showed an H-type tracheoesophageal fistula. — The host summarizing a resource [Ep 16 · 0:30](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=30)
- There were 2 prior attempts at endoluminal ablation before this thoracoscopic repair. — The host summarizing a resource [Ep 16 · 0:45](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=45)
- The patient was examined at 2 weeks postoperatively and the fistula was assessed at 3 months. — The host summarizing a resource [Ep 16 · 4:36](https://qa.library.globalcastmd.com/watch/vats-h-type-fistula-repair-technique-749?t=276)
- More than 50% of long-gap EA cases are type C. — The host summarizing the discussion [Ep 3 · 5:01](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=301)
- A paper by Upadhaya in the European Journal of Pediatric Surgery reported that ligating the azygos vein increases the rate of pneumonia. — The host summarizing the discussion [Ep 3 · 7:09](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=429)
- David Vander says he never dissects the azygos vein and that not doing so decreases the rate of complications. — The host summarizing the discussion [Ep 3 · 7:09](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=429)
- Keith Jorgeson advises not to use just a clip to ligate the fistula. — Spitz summarizing the discussion [Ep 3 · 7:50](https://qa.library.globalcastmd.com/watch/tips-and-tricks-ea-tef-1075?t=470)

---
Educational content from recorded physician discussions — not medical advice. Cite the canonical URL or the ?t= deep link. Policy: https://qa.library.globalcastmd.com/ai