# Tracheoesophageal Fistula — GCMD Library living collection

Everything in the library about tracheoesophageal fistula — built automatically from dossiers that name it.

Updated: n/a · 13 episodes · 389 cited statements

## Episodes
### Fundamentals
- [Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001) — video · 2:11 · [machine version](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001.md)

### Surgical Management
- [Thoracoscopic Repair of Tracheo-esophageal Fistula Tricks: Pediatric Surgery...](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424) — video · 19:14 · [machine version](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424.md)
- [TEF Presentations (Extended): Aerodigestive & Esophageal Surgery](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037) — video · 108:11 · [machine version](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037.md)
- [Tracheoesophageal Fistula with Dr. Daniel von Allmen](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300) — podcast · 45:21 · [machine version](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300.md)
- [Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791) — podcast · 10:56 · [machine version](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791.md)
- [QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114) — video · 7:37 · [machine version](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114.md)
- [Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169) — video · 66:48 · [machine version](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169.md)

### Evidence & Research
- [Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356) — video · 18:17 · [machine version](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356.md)
- [Case Based Journal Review: Esophageal Atresia in 2022](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631) — podcast · 17:55 · [machine version](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631.md)
- [Quick Literature Updates Episode 9](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770) — video · [machine version](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770.md)

### Case-Based Learning
- [Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739) — video · 120:59 · [machine version](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739.md)

### In-Depth Reviews
- [Esophageal Atresia](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627) — video · 39:30 · [machine version](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627.md)

### Long-Term Care
- [QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201) — video · 10:19 · [machine version](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201.md)

## Chapters
- [0:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=0) Introduction and Multidisciplinary Center Structure (Ep 6)
- [3:17](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=197) Initial Assessment and Preoperative Workup (Ep 6)
- [7:08](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=428) Right-Sided Arch Management and Timing of Surgery (Ep 6)
- [11:21](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=681) Emergency Management of Severe Abdominal Distention (Ep 6)
- [14:30](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=870) Intraoperative Bronchoscopy and Open Technique (Ep 6)
- [19:25](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1165) Mobilization Techniques and Tracheal Injury Management (Ep 6)
- [23:53](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1433) Anastomotic Technique and Long-Gap Management (Ep 6)
- [29:06](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1746) Thoracoscopic Approach and Port Placement (Ep 6)
- [35:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2120) Postoperative Management and Extubation (Ep 6)
- [38:23](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2303) Stricture Management and Dilation Protocol (Ep 6)
- [43:26](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2606) Fundoplication Indications and Pure Atresia Approach (Ep 6)
- [0:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=0) Introduction and session framing (Ep 1)
- [0:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=40) Historical context and terminology clarification (Ep 1)
- [1:46](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=106) Rothenberg's initial experience and proposed benefits (Ep 1)
- [4:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=240) Single-center comparative study from Tübingen (Ep 1)
- [5:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=340) Multi-center international experience (Holcomb series) (Ep 1)
- [7:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=430) Japanese multi-center study and musculoskeletal concerns (Ep 1)
- [8:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=520) Long-term musculoskeletal outcomes study (Ep 1)
- [10:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=600) Meta-analyses: 2012 and 2016 studies (Ep 1)
- [10:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=650) Pilot randomized controlled trial (Ep 1)
- [11:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=670) Conclusions and audience poll results (Ep 1)
- [12:06](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=726) Faculty discussion: Rothenberg's perspective on thoracotomy morbidity (Ep 1)
- [14:57](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=897) Training paradigm challenges in the United States (Ep 1)
- [16:56](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=1016) Debate on patient selection and technical visualization (Ep 1)
- [0:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=0) Introduction and technique overview: partial fistula division (Ep 2)
- [4:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=270) Video demonstration of surgical technique (Ep 2)
- [9:45](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=585) Faculty discussion: alternative techniques and clip use (Ep 2)
- [14:28](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=868) Clip erosion concerns and future directions (Ep 2)
- [0:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=0) Introduction and Initial Workup of Esophageal Atresia (Ep 3)
- [7:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=420) Surgical Approach: Right vs. Left Thoracotomy and Aortic Arch Position (Ep 3)
- [15:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=900) Role of Preoperative Bronchoscopy (Ep 3)
- [22:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1320) Open Repair Technique and Suture Material (Ep 3)
- [28:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1680) Thoracoscopic Repair: Indications, Technique, and Training Challenges (Ep 3)
- [35:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2100) Long-Gap Atresia Management and Esophageal Replacement (Ep 3)
- [0:00](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=0) Introduction and Aspiration Framework (Ep 4)
- [10:40](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=640) Case 1: Second H-Type TEF After Primary Repair (Ep 4)
- [22:00](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1320) Dual-Scope Technique and Endoscopic TEF Repair (Ep 4)
- [35:00](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2100) Positive-Pressure Air Test and Repeat Endoscopic Repair (Ep 4)
- [50:00](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3000) Complex Case: Type D TEF and Slide Tracheoplasty (Ep 4)
- [60:00](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3600) Button Battery Injuries and Slide Tracheoplasty Failures (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "The bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas." — Todd Ponsky (opinion) [Ep 5 · 0:04](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4)
- "A 70-degree endoscope is a difficult tool to use but useful for tracking down hard-to-find tracheoesophageal fistulas." (clinical) [Ep 5 · 0:37](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=37)
- "Routine bronchoscopy is now standard practice for all type C esophageal atresia cases, though this represents a change from earlier training when it was not necessarily performed." — Dan (clinical) [Ep 5 · 1:13](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=73)
- "General surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment." — Todd Ponsky (opinion) [Ep 5 · 1:53](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=113)
- "Pediatric surgery fellows at this institution complete a one-month attachment with ENT to perform bronchoscopies as part of their training." (clinical) [Ep 5 · 2:22](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=142)
- "Dual scoping (simultaneous bronchoscopy and esophagoscopy) is enormously valuable for complicated TEF patients, providing different information and advantages in visualization." — Dan (clinical) [Ep 5 · 6:41](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=401)
- "During dual scoping, you can see the light from one scope through the epithelium, inject material that may come through subtle holes, or observe bubbles from air insufflation, making simultaneous visualization quite valuable." — Phil (clinical) [Ep 5 · 7:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=453)
- "For combined bronchoscopy and esophagoscopy in small children, a 2.8 mm flexible bronchoscope is typically used alongside an infant gastroscope (5.4 or 6 mm outer diameter)." — Phil (clinical) [Ep 5 · 8:19](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=499)
- "An infant gastroscope will fit retrograde through a 16 French gastrostomy tube." — Phil (clinical) [Ep 5 · 8:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=516)
- "The concept of endoscopic TEF repair is to demucosalize the tract because mucosa is a non-stick surface; you want raw against raw with a tiny bit of fibrin glue to seal it while it scars off." (clinical) [Ep 5 · 11:01](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=661)
- "When using fibrin glue for TEF repair, use a very small amount (about 0.1 ml) via a Duplo double-lumen catheter to avoid forming a foreign body." (clinical) [Ep 5 · 11:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=696)
- "Trichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control." — Todd Ponsky (clinical) [Ep 5 · 12:21](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=741)
- "When using bugbee cautery for TEF repair, place something in the esophagus (such as an endotracheal tube) as a spacer to avoid burning the back of the esophageal wall." (clinical) [Ep 5 · 13:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=816)
- "A bugbee catheter will go down an EGD scope, allowing cauterization from the esophageal side if the tract angle is favorable." (clinical) [Ep 5 · 14:29](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=869)
- "A 3 French bugbee fits through a 2.8 mm flexible bronchoscope with a 1.2 mm suction channel, providing precise control of the tip." — Bob Wood (clinical) [Ep 5 · 15:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=910)
- "When passing a bugbee through a rigid scope, bending the end at a slight angle before insertion allows steering by rotation." (clinical) [Ep 5 · 15:32](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=932)
- "Endoscopic TEF repair often needs to be performed more than once; the average is approximately 2 procedures, with some requiring 1 and others 3-4 attempts." (clinical) [Ep 5 · 22:37](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1357)
- "The success rate for endoscopic TEF closure is running about 80%, not 100%." (clinical) [Ep 5 · 24:18](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1458)
- "After 3 or 4 failed endoscopic TEF repair attempts, it is typically time to give up and discuss alternative approaches." (clinical) [Ep 5 · 24:27](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1467)
- "When cauterizing a TEF, you should particularly try to get the edges and sides because as they scar in, that will narrow the whole mouth, making re-intervention easier if needed." (clinical) [Ep 5 · 24:59](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1499)
- "To reduce airway fire risk during bugbee cautery, insufflated oxygen should be kept at 30% or less." (clinical) [Ep 5 · 25:51](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1551)
- "Patients can tolerate a minute or two of lower oxygen saturation during cautery procedures to maintain safe oxygen levels below 30%." — Bob Wood (clinical) [Ep 5 · 26:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1570)
- "Radiance voice gel (used for vocal cord injection) can be injected into the wall beside a TEF to obliterate the potential space and hold raw surfaces together; it only lasts a few weeks." (clinical) [Ep 5 · 27:05](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1625)
- "For TEF repair, all that matters is achieving raw-on-raw tissue contact for healing." — Todd Ponsky (clinical) [Ep 5 · 69:25](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4165)
- "Thoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact." — Todd Ponsky (opinion) [Ep 5 · 69:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4173)
- "Slide tracheoplasty is a useful technique for big complex TEF holes, using part of the trachea to repair the esophageal defect." (clinical) [Ep 5 · 30:55](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1855)
- "Sternal periosteum is an excellent interposition graft material—it is like Kevlar, bulletproof, abundant, and very strong, though almost impossible to suture." (clinical) [Ep 5 · 34:02](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2042)
- "Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation, unlike many operations where the surgeon does not matter long-term." (opinion) [Ep 5 · 57:09](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3429)
- "Button batteries are extremely dangerous and can cause ongoing tissue damage that extends beyond what is visible and beyond the expected time frame." — Dan (clinical) [Ep 5 · 43:17](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2597)
- "The institutional protocol for button battery ingestion is to remove them within 2 hours of identification, as it is considered a medical emergency." — Phil (guideline) [Ep 5 · 44:04](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2644)
- "Dead button batteries still have about 2 volts and continue to cause damage." — Todd Ponsky (host_summary) [Ep 5 · 45:31](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2731)
- "Button batteries can be distinguished from coins on AP X-ray by a visible rim, eliminating the need for a lateral view." — Todd Ponsky (host_summary) [Ep 5 · 45:37](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2737)
- "The American Society of Pediatric Otolaryngology has a task force working to introduce legislation requiring skull-and-crossbones etching on all button batteries to distinguish them from coins on X-ray." (guideline) [Ep 5 · 44:22](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2662)
- "In the series of approximately 12 slide tracheoplasties for TEF, there were two failures, both in button battery cases, and both patients were the only button battery cases in the series." (clinical) [Ep 5 · 41:00](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2460)
- "For button battery ingestions, if there was a witnessed ingestion, the patient is asymptomatic, removal occurs within a couple of hours, and the mucosa looks good, the likelihood of doing well is high." — Phil (clinical) [Ep 5 · 46:02](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2762)
- "Late deaths from aortoesophageal fistulas have occurred following unwitnessed button battery ingestions that were not terribly prolonged." — Phil (clinical) [Ep 5 · 46:18](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2778)
- "For button battery cases, CT angiography to look at the aorta may provide as much information about risk of sudden death as endoscopic evaluation, though sensitivity data is lacking." — Phil (opinion) [Ep 5 · 47:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2830)
- "The style of button battery matters for risk: large round flat 3-volt batteries are by far the most potentially damaging, while smaller fatter batteries pose less risk." (clinical) [Ep 5 · 48:01](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2881)
- "The protocol is to remove button batteries from the stomach because if they do not leave and sit in one spot, they create considerable injury, especially in the distal stomach/antrum where scarring or stenosis can occur." — Phil (clinical) [Ep 5 · 49:22](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=2962)
- "For transtracheal TEF repair, a three-layer closure is performed: esophageal layer with knots in the esophageal lumen, interposition graft (typically sternal periosteum), and tracheal layer with knots in the tracheal lumen to reduce refistulization risk." (clinical) [Ep 5 · 54:11](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3251)
- "Transtracheal repair is a relatively two-dimensional operation where the surgeon matters less than in three-dimensional operations like slide tracheoplasty." (opinion) [Ep 5 · 56:21](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3381)
- "The primary complication of transtracheal TEF repair is refistulization, whereas slide tracheoplasty complications include dehiscence, which is a much bigger deal." (clinical) [Ep 5 · 56:03](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3363)
- "When repairing high H-type fistulas from a thoracic approach, there is a temptation to ligate the fistula on the esophageal side, which can leave a large tracheal pouch/diverticulum that causes problems if the patient needs a tracheostomy." (clinical) [Ep 5 · 64:18](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3858)
- "Endoscopic suturing in the trachea is remarkably humbling and painful, and the hardest part is tying the knot." (opinion) [Ep 5 · 68:11](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4091)
- "Nitinol clips could theoretically be used for endoscopic TEF repair, though they are permanent." — Dan (opinion) [Ep 5 · 68:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4113)
- "Metal clips can be used with endoscopic sutures for laryngeal cleft repairs from the esophageal side to hold sutures; the patient swallows the clip when the PDS dissolves." (clinical) [Ep 5 · 69:01](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4141)
- "Anal fistula plugs made of biologic material (surgesis) can be used for TEF repair by wrapping them with barbed VOC suture and inserting them into the fistula tract to promote scarring and collagen matrix formation." — Todd Ponsky (clinical) [Ep 5 · 97:24](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5844)
- "Long skinny TEF tracts from proximal to distal are the ideal candidates for endoscopic repair, while short, fat, wide tracts do not tend to do well with endoscopic techniques." (clinical) [Ep 5 · 63:58](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3838)
- "H-type fistulas are relatively short tracks straight from trachea to esophagus and do not do nearly as well with endoscopic repair compared to longer tracts." (clinical) [Ep 5 · 63:46](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=3826)
- "Positive pressure testing for TEF involves placing an endotracheal tube with cuff in the esophagus and applying 30 cm H2O pressure of air, then observing for air blowing out of the fistula; the stomach must be suctioned afterward." (clinical) [Ep 5 · 21:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1296)
- "For proximal fistulas, intubation with a cuffed tube past the hole is preferred so the cuff holds the hole occluded during repair; this is not possible for fistulas on the carina." (clinical) [Ep 5 · 23:29](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1409)
- "One of the problems with endoscopic TEF cauterization is not being aggressive enough; you need to destroy the mucosa, not just give it a fright." — Bob Wood (clinical) [Ep 5 · 17:42](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1062)
- "With a flexible bronchoscope, you can insufflate through the suction channel and distend the lumen to get a better view and sweep the inside of the lumen during cauterization." — Bob Wood (clinical) [Ep 5 · 18:03](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1083)
- "Laryngeal clefts are incredibly easy to miss and must be actively looked for and probed, not just visually inspected." (clinical) [Ep 5 · 20:10](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=1210)
- "A flexible bronchoscope is not a reliable tool for diagnosing laryngeal clefts; you cannot find them even when you know they are there 95% of the time due to limitations of flexible instrumentation." — Bob Wood (clinical) [Ep 5 · 103:43](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6223)
- "For anything suspected in the posterior commissure, subglottic space, or cervical trachea, a rigid scope with probing is mandatory, not just visual inspection." — Bob Wood (clinical) [Ep 5 · 104:02](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6242)
- "The retroflexed (upside-down) flexible bronchoscopy technique allows greater angulation at the scope tip in one direction than the opposite, making it useful for examining the posterior tracheal wall." — Bob Wood (clinical) [Ep 5 · 73:30](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4410)
- "Insufflating with oxygen through the suction channel at about 2 L/min during bronchoscopy spreads tissue apart, does not hurt respirations, and gives a better view." — Bob Wood (clinical) [Ep 5 · 74:15](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4455)
- "When advancing a flexible bronchoscope through the nose and glottis, it is very easy to miss pathology in the cervical trachea and subglottis; it is easier to see these areas while slowly withdrawing the scope than while advancing." — Bob Wood (clinical) [Ep 5 · 74:51](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4491)
- "High tracheoesophageal fistulas are very difficult to find from the esophageal side because they are just below the esophageal inlet where a forward-viewing gastroscope does not deflect well enough to get an en face view." — Phil (clinical) [Ep 5 · 4:43](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=283)
- "Going retrograde up the esophagus provides easier maneuvering just below the esophageal inlet for finding high fistulas." — Phil (clinical) [Ep 5 · 5:17](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=317)
- "Bronchoesophageal fistulas can be very hard to find because there are so many subsegmental bronchi." (clinical) [Ep 5 · 5:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=336)
- "During dual scoping for bronchoesophageal fistula, you can shake hands across the fistula if you can track it down, and seeing the other operator's scope is usually a giveaway." (clinical) [Ep 5 · 5:50](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=350)
- "During dual scoping, you can see the light from the other scope through the epithelium, inject material that may come through a hole, or see bubbles from insufflation, making simultaneous scoping quite valuable." — Phil (clinical) [Ep 5 · 7:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=453)
- "Operators can turn off their light during dual scoping so the other person can see their light and determine if they are in the right region." (clinical) [Ep 5 · 7:58](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=478)
- "A 2.8 mm flexible bronchoscope is typically used for combined procedures, and the GI scope for small children is an infant scope (5.4 or 6 mm outer diameter)." — Phil (clinical) [Ep 5 · 8:19](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=499)
- "An infant gastroscope will fit retrograde through a 16 French gastrostomy tube, which is why 16 French G-tubes are preferred over 14 French." — Phil (clinical) [Ep 5 · 8:36](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=516)
- "A bronchoscope can be used retrograde in the esophagus because it fits through smaller openings." — Bob Wood (clinical) [Ep 5 · 8:57](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=537)
- "For patients with Down syndrome, swallow studies are difficult to interpret due to cooperation issues." (clinical) [Ep 5 · 71:25](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4285)
- "If a patient is clinically aspirating with a history of TEF repair, maintain a high index of suspicion for recurrent fistula or laryngeal cleft even if initial studies are negative." (clinical) [Ep 5 · 71:44](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4304)
- "After TEF repair, patients may have persistent bronchiectasis from years of aspiration, requiring months of care with vibrating vest and chest physiotherapy even after successful fistula closure." (clinical) [Ep 5 · 82:40](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=4960)
- "Tracheal pouches/diverticula can cause problems during tracheostomy tube changes because the tube may go into the pouch instead of the trachea, causing the patient to decompensate." (clinical) [Ep 5 · 104:45](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6285)
- "Tracheal pouches can be marsupialized using a Storz ClickLine biopsy forceps (pediatric laparoscopic instrument) with suction and cautery at about 40 watts to divide the common party wall." (clinical) [Ep 5 · 105:12](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6312)
- "Marsupializing tracheal pouches can make tracheomalacia worse symptomatically, though usually it does not and kids do well." — Bob Wood (clinical) [Ep 5 · 106:00](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6360)
- "After marsupialization of tracheal pouches, what remains tends to scar to the sides and becomes almost invisible." (clinical) [Ep 5 · 106:29](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=6389)
- "Hearing aid molds are radiolucent and can be missed on chest X-ray." (clinical) [Ep 5 · 84:50](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5090)
- "Airway stents can erode and create new fistulas into the esophagus." (clinical) [Ep 5 · 87:49](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5269)
- "A Y-shaped stent placed in both bronchi and up the trachea with a trach tube into the stent can successfully bypass a bronchoesophageal fistula, allowing significant clinical improvement." (clinical) [Ep 5 · 88:07](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5287)
- "Pectus excavatum can worsen tracheobronchomalacia, and sternotomy for other procedures can make the pectus worse." (clinical) [Ep 5 · 86:40](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5200)
- "Placing a pectus bar can improve severe tracheobronchomalacia by pulling the chest wall forward." (clinical) [Ep 5 · 87:33](https://qa.library.globalcastmd.com/watch/tef-presentations-aerodigestive-esophageal-surgery-1037?t=5253)
- "Patients with a transanastomotic tube had a 2.72 times higher risk of developing a stricture post-operatively after esophageal atresia with tracheoesophageal fistula repair" (clinical) [Ep 9 · 1:10](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=70)
- "The Midwest Pediatric Surgery Consortium study examined every patient who had a laparoscopic pyloric myotomy to identify patent processus vaginalis and followed them annually" (clinical) [Ep 9 · 1:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=90)
- "Of 526 patients enrolled in the PPV study, 283 had a patent processus vaginalis (bilateral, right, or left)" (epidemiological) [Ep 9 · 2:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=120)
- "Of 208 patients with at least one year follow-up, only three underwent inguinal hernia repair, all within the first year" (clinical) [Ep 9 · 2:13](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=133)
- "Most patent processus vaginalis do not turn into inguinal hernias based on four-year interim analysis data" (clinical) [Ep 9 · 2:35](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=155)
- "Liver transplantation for biliary atresia can be performed as initial treatment (primary) or after failed Kasai hepatoportoenterostomy (salvage)" (clinical) [Ep 9 · 2:45](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=165)
- "The current standard in the US for biliary atresia is Kasai first and liver transplant only if that fails" (guideline) [Ep 9 · 3:05](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=185)
- "Children who had an early salvage liver transplant (before age one) and children who had a primary liver transplant had similar outcomes" (clinical) [Ep 9 · 3:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=210)
- "Children who had a late salvage liver transplant had improved graft survival compared to other groups" (clinical) [Ep 9 · 3:45](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=225)
- "Some children who undergo the Kasai procedure will never end up needing a liver transplant" (clinical) [Ep 9 · 4:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=240)
- "Social risk screening in pediatrics involves screening for risk factors including food and housing insecurity, financial strain, and unsafe environments" (clinical) [Ep 9 · 4:30](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=270)
- "There is low concordance between screening results showing who might need resources and who is actually asking for more resources" (epidemiological) [Ep 9 · 5:00](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=300)
- "Families may feel uncomfortable with social risk screening and may think there might be downstream repercussions based on their answers" (opinion) [Ep 9 · 5:15](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=315)
- "There may be racial biases in screening practices, with non-white patients potentially being asked social risk questions more often" (epidemiological) [Ep 9 · 5:28](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=328)
- "Current social risk screening protocols may not be effective and may actually lead to more inequities" (opinion) [Ep 9 · 4:50](https://qa.library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=290)
- "Slide tracheoplasty can be used as a method of repairing challenging tracheoesophageal fistulas" — Michael Rutter (clinical) [Ep 10 · 0:49](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=49)
- "In a case with complete tracheal rings and TEF, both conditions were repaired simultaneously because there was no other option" — Michael Rutter (clinical) [Ep 10 · 1:11](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=71)
- "The slide tracheoplasty technique involves transecting the trachea above and below the hole with a bevel to avoid losing too much trachea" — Michael Rutter (clinical) [Ep 10 · 1:25](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=85)
- "Part of the trachea is used to repair the esophagus, then the trachea is slid over the top of it, often with a periosteal interposition graft" — Michael Rutter (clinical) [Ep 10 · 1:35](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=95)
- "Finding an H-type TEF can be quite difficult and is done via tracheoscopy or esophagoscopy" — Kim Pribben (host_summary) [Ep 10 · 2:06](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=126)
- "In the slide tracheoplasty repair, a flap of trachea is sewn onto the esophagus so the front wall of the esophagus becomes a piece of trachea, using a quick running suture technique with 4-0 PDS" — Michael Rutter (clinical) [Ep 10 · 2:18](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=138)
- "When the distance between trachea and esophagus is large, using nerve hooks and slowly tightening multiple throws brings the structures together" — Michael Rutter (clinical) [Ep 10 · 2:47](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=167)
- "Serial esophagoscopies provide a good picture of outcomes in challenging TEF repair cases" — Kim Pribben (host_summary) [Ep 10 · 2:59](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=179)
- "In the Swedish patient case, esophagoscopy at one month post-op showed the suture line where trachea was sewn to esophagus with the front wall being a piece of trachea" — Michael Rutter (clinical) [Ep 10 · 3:08](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=188)
- "The Swedish patient returned to eating and drinking everything despite having a very short trachea" — Michael Rutter (clinical) [Ep 10 · 3:24](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=204)
- "In the 4-year-old case, initial stabilization was achieved by placing an esophageal stent, which did not fix the holes but eliminated the mediastinal communication" — Michael Rutter (clinical) [Ep 10 · 4:23](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=263)
- "A slide tracheoplasty open approach provides much better visualization in the operating field for complex cases" — Kim Pribben (host_summary) [Ep 10 · 4:42](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=282)
- "A transsternal, transtracheal approach provides fantastic exposure to the esophagus" — Michael Rutter (clinical) [Ep 10 · 4:50](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=290)
- "Tibial periosteum serves as a good interposition graft" — Michael Rutter (clinical) [Ep 10 · 4:55](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=295)
- "Periosteum is effective at protecting one lumen from another" — Michael Rutter (clinical) [Ep 10 · 5:05](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=305)
- "A pulmonologist aids the surgeon by looking down the ET tube, which allows for additional visualization and identification of the fistula" — Kim Pribben (host_summary) [Ep 10 · 5:34](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=334)
- "The repair includes transection of the trachea and esophagus, performing a slide esophagoplasty, placing the interposition graft, and closing the trachea" — Kim Pribben (host_summary) [Ep 10 · 5:42](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=342)
- "In the 4-year-old case, the patient was extubated the next day with esophagram and bronchoscopy performed at one week" — Kim Pribben (host_summary) [Ep 10 · 6:03](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=363)
- "The 4-year-old patient was back to eating ice cream at 10 days post-op" — Kim Pribben (host_summary) [Ep 10 · 6:09](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=369)
- "Slide tracheoplasty is not appropriate for every TEF case, but it is useful to know the option is available" — Michael Rutter (opinion) [Ep 10 · 6:26](https://qa.library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=386)
- "Cincinnati Children's Hospital hosted the Quad Conference in October 2022, combining four conferences: International Organization for Esophageal Atresia, Aerodigestive Society Conference, Cincinnati Children's Airway Course, and Cincinnati Children's Pediatric Dysphagia Series." — Lizzie Lee (host_summary) [Ep 11 · 0:15](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=15)
- "Cincinnati Children's has one of the largest aerodigestive centers in the world." — Lizzie Lee (host_summary) [Ep 11 · 0:47](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=47)
- "The expert multidisciplinary team includes speech pathology, otolaryngology, gastroenterology, pulmonology, and pediatric general surgery." — Lizzie Lee (host_summary) [Ep 11 · 0:55](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=55)
- "The vision of the Aerodigestive and Esophageal Center is to improve efficiency and communication between team members and the family." — Claire Miller (clinical) [Ep 11 · 1:28](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=88)
- "The center provides coordinated multidisciplinary care to children with congenital or acquired complex digestive and airway disorders." — Lizzie Lee (host_summary) [Ep 11 · 1:37](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=97)
- "The clinical assessment is a poor predictor when there are airway protection issues." — Claire Miller (clinical) [Ep 11 · 2:44](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=164)
- "Video fluoroscopic swallowing study analyzes different phases of swallowing." — Lizzie Lee (host_summary) [Ep 11 · 2:52](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=172)
- "FEES (fiber optic endoscopic evaluation of swallowing study) allows visualization of pharyngeal and laryngeal structures and assessment of function, aspiration, and residual after each swallow." — Lizzie Lee (host_summary) [Ep 11 · 2:59](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=179)
- "High-resolution pharyngeal manometry allows objective assessment of the pressures of the swallow to understand what is underlying a swallowing dysfunction." — Claire Miller (clinical) [Ep 11 · 3:13](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=193)
- "ENT looks at swallowing study results and helps stratify the risk of proceeding with airway reconstruction and decannulation." — Lizzie Lee (host_summary) [Ep 11 · 3:48](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=228)
- "In aerodigestive patients, ENT performs esophageal and airway reconstruction, cleft repair, drool procedures, and manages vocal folds and mobility." — Lizzie Lee (host_summary) [Ep 11 · 3:54](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=234)
- "GERD pathophysiology includes an incompetent lower esophageal sphincter." — Lizzie Lee (host_summary) [Ep 11 · 4:19](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=259)
- "Patients with TEF have a lot of other things other than incompetent lower esophageal sphincters, including motility problems, hernias, and delayed emptying." — Scott Pentik (clinical) [Ep 11 · 4:31](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=271)
- "General signs and symptoms of GERD include regurgitation, vomiting, and heartburn." — Lizzie Lee (host_summary) [Ep 11 · 4:42](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=282)
- "Impedance is a tool used to measure reflux and distinguish between a swallow versus actual reflux." — Scott Pentik (clinical) [Ep 11 · 4:48](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=288)
- "Patients with eosinophilic esophagitis often have procedures performed on them even before their diagnosis." — Scott Pentik (clinical) [Ep 11 · 5:21](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=321)
- "Data shows an increase in airway surgery complications in patients who were later found to have eosinophilic esophagitis." — Lizzie Lee (host_summary) [Ep 11 · 5:28](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=328)
- "The center now performs endoscopy as part of workup prior to even considering surgery." — Scott Pentik (guideline) [Ep 11 · 5:35](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=335)
- "Anatomic issues in aerodigestive patients include strictures that need balloon dilations or stenting." — Lizzie Lee (host_summary) [Ep 11 · 5:40](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=340)
- "Kids will have Nissans and then have hernias later." — Scott Pentik (clinical) [Ep 11 · 5:49](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=349)
- "Motility issues after TEF repairs include narrowing of the esophagus and the esophagus not squeezing, leading to more reflux, more dysphagia, and impactions." — Scott Pentik (clinical) [Ep 11 · 5:58](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=358)
- "When 25 patients in the aerodigestive program were assessed, 76% of them had a feeding disorder." — Lizzie Lee (host_summary) [Ep 11 · 6:13](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=373)
- "Patients at risk for pulmonary insufficiency include preemies with chronic lung disease, patients with restrictive lung disease, congenital or acquired abnormalities, and heart disease like pulmonary hypertension." — Lizzie Lee (host_summary) [Ep 11 · 6:54](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=414)
- "Patients at risk for pulmonary insufficiency typically present with chronic symptoms including tachypnea, shortness of breath, retractions, non-apneic hypoxemia, and in older patients, exercise intolerance." — Sherry Torres Silva (clinical) [Ep 11 · 7:06](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=426)
- "Underlying pulmonary insufficiency should be suspected if patients have had complicated respiratory infections requiring positive pressure ventilation." — Lizzie Lee (host_summary) [Ep 11 · 7:20](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=440)
- "Patients at risk for chronic pulmonary aspiration include preemie babies, those with swallowing dysfunction, GI dysmotility, cardiothoracic esophageal and airway history, and syndromes including CHARGE syndrome, Mobius, Criducha, and trisomy." — Sherry Torres Silva (clinical) [Ep 11 · 7:32](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=452)
- "Risk factors for upper airway obstruction include airway abnormalities like mid-face hypoplasia, skeletal dysplasia, decreased muscle tone, and syndromes associated with airway obstruction." — Lizzie Lee (host_summary) [Ep 11 · 7:48](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=468)
- "Patients with airway obstruction, especially upper airway, will have symptoms with sleep and significant exertion or agitation, and noisy breathing might be one of the most significant symptoms reported." — Sherry Torres Silva (clinical) [Ep 11 · 8:02](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=482)
- "Risk factors for lower airway obstruction include acquired or congenital thoracic deformities and those who had thoracotomies done in the past." — Lizzie Lee (host_summary) [Ep 11 · 8:13](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=493)
- "Tracheomalacia is a very common comorbidity in patients with history of esophageal fistula or atresia." — Sherry Torres Silva (clinical) [Ep 11 · 8:22](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=502)
- "High-resolution CT is the gold standard for diagnosis because it is highly sensitive and detects early changes of the small airways, and 3D reconstructions can be performed." — Sherry Torres Silva (clinical) [Ep 11 · 8:36](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=516)
- "Flexible bronchoscopy is used starting in the nose and ending in the subsegmental bronchi, and bronchoalveolar lavage helps with identification of infections and markers of aspiration." — Sherry Torres Silva (clinical) [Ep 11 · 8:49](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=529)
- "Pulmonologists perform medical management of aspiration including control of sialorrhea, optimization of airway clearance, and use of anti-inflammatory medications for chronic aspiration or inflammation." — Sherry Torres Silva (clinical) [Ep 11 · 9:02](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=542)
- "For patients with ventilatory insufficiency, the pulmonologist determines if the child still needs ventilatory support and whether they are ready for decannulation." — Lizzie Lee (host_summary) [Ep 11 · 9:15](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=555)
- "The pulmonologist assesses how ready the patient is for weaning from the vent and whether they can start or advance feeding." — Lizzie Lee (host_summary) [Ep 11 · 9:26](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=566)
- "In the NICU, general surgeons obtain feeding access, manage anorectal malformations, and perform surgical procedures such as tracheopexies and lung resections." — Lizzie Lee (host_summary) [Ep 11 · 9:41](https://qa.library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=581)
- "Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis)." — Michael Rutter (clinical) [Ep 4 · 4:39](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=279)
- "Lipid-laden macrophages are non-specific markers of aspiration; their recovery depends on the lipid content of aspirated material, the amount aspirated, and time since aspiration." — Bob Wood (clinical) [Ep 4 · 8:05](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=485)
- "Multi-channel intraluminal impedance testing detects reflux but does not diagnose aspiration; it tells you whether something is delivered from the stomach to the esophagus, not what happens after." — Phil Putnam (clinical) [Ep 4 · 9:38](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=578)
- "If a patient is aspirating from above (oropharyngeal or esophageal source), an anti-reflux procedure does not help and may make them worse." — Daniel von Allmen (clinical) [Ep 4 · 9:58](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=598)
- "A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas." — Michael Rutter (clinical) [Ep 4 · 12:10](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=730)
- "A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes." — Michael Rutter (clinical) [Ep 4 · 13:21](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=801)
- "Routine bronchoscopy is now standard practice for all type C TEF repairs at Cincinnati Children's, often done in collaboration with ENT colleagues." — Daniel von Allmen (clinical) [Ep 4 · 14:02](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=842)
- "Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise." — Michael Rutter (clinical) [Ep 4 · 14:51](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=891)
- "Dual scoping (simultaneous bronchoscopy and esophagoscopy) allows scopes to 'shake hands' across a fistula, light transillumination through tissue, and injection of saline or air to reveal subtle openings." — Daniel von Allmen (clinical) [Ep 4 · 19:37](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1177)
- "A 2.8 mm flexible bronchoscope and a 5.4–6 mm infant gastroscope are the typical scopes used for combined airway-esophageal examination in small children." — Phil Putnam (clinical) [Ep 4 · 21:02](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1262)
- "Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs." — Michael Rutter (clinical) [Ep 4 · 23:41](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1421)
- "Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered." — Michael Rutter (clinical) [Ep 4 · 37:01](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2221)
- "Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening." — Michael Rutter (clinical) [Ep 4 · 34:20](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2060)
- "Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks." — Michael Rutter (clinical) [Ep 4 · 39:48](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2388)
- "Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair." — Michael Rutter (clinical) [Ep 4 · 45:48](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2748)
- "Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture." — Michael Rutter (clinical) [Ep 4 · 46:52](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2812)
- "Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification." — Michael Rutter (guideline) [Ep 4 · 53:37](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3217)
- "Button battery injuries in the esophagus can progress to aortoesophageal fistula; CT angiography and close follow-up for 6 weeks post-removal are recommended, especially if the battery was at the aortoesophageal junction." — Phil Putnam (guideline) [Ep 4 · 59:02](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3542)
- "Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges." — Michael Rutter (clinical) [Ep 4 · 54:02](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3242)
- "Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event." — Michael Rutter (opinion) [Ep 4 · 69:04](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4144)
- "Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen)." — Michael Rutter (clinical) [Ep 4 · 64:43](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3883)
- "In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches." — Michael Rutter (clinical) [Ep 4 · 94:43](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5683)
- "Flexible bronchoscopy cannot reliably diagnose laryngeal clefts; rigid microlaryngoscopy with active probing is mandatory when posterior glottic pathology is suspected." — Bob Wood (clinical) [Ep 4 · 116:27](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6987)
- "When examining the cervical trachea and subglottis with a flexible bronchoscope, it is easier to see pathology while slowly withdrawing the scope than while advancing it, due to the need to flex and extend the tip to navigate the glottis." — Bob Wood (clinical) [Ep 4 · 87:43](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5263)
- "Insufflation with oxygen at 2 L/min through the suction channel of a flexible bronchoscope spreads tissue apart, improves visualization, and does not impair respirations." — Bob Wood (clinical) [Ep 4 · 86:58](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5218)
- "The degree of angulation at the tip of a flexible bronchoscope is much greater in one direction (retroflexion) than the other; rotating the scope 180° (Sabode maneuver) can reveal posterior tracheal pathology more easily." — Bob Wood (clinical) [Ep 4 · 86:30](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5190)
- "Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection." — Michael Rutter (clinical) [Ep 4 · 107:43](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6463)
- "In a patient with multiple bronchoesophageal fistulas and chronic bronchiectasis, lobectomy with resection of the esophageal pseudo-diverticulum can be performed safely; the esophagus can be primarily closed if not strictured." — Daniel von Allmen (clinical) [Ep 4 · 112:36](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6756)
- "A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible." — Michael Rutter (clinical) [Ep 4 · 100:56](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6056)
- "Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement." — Michael Rutter (clinical) [Ep 4 · 118:01](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=7081)
- "When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable." — Michael Rutter (clinical) [Ep 4 · 38:35](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2315)
- "A 3-French bugbee cautery fits through the 1.2 mm suction channel of a 2.8 mm flexible bronchoscope, allowing precise control and steering of the cautery tip." — Bob Wood (clinical) [Ep 4 · 27:54](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1674)
- "Trichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion." — Todd Ponsky (clinical) [Ep 4 · 25:08](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1508)
- "Anal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring." — Todd Ponsky (clinical) [Ep 4 · 110:04](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6604)
- "Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained." — Michael Rutter (opinion) [Ep 4 · 69:59](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4199)
- "After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required." — Michael Rutter (clinical) [Ep 4 · 95:23](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5723)
- "Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized." — Michael Rutter (clinical) [Ep 4 · 97:35](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5855)
- "Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy." — Michael Rutter (clinical) [Ep 4 · 99:49](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5989)
- "Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent)." — Michael Rutter (clinical) [Ep 4 · 100:32](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6032)
- "When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction." — Michael Rutter (clinical) [Ep 4 · 77:21](https://qa.library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4641)
- "At Cincinnati Children's, if a child has no gas in the abdomen, they place a G-tube and may put something up the distal esophagus for a fluoro shot, then wait a couple of weeks for a protocol gap measurement in interventional radiology." — Daniel von Allmen (clinical) [Ep 7 · 0:46](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=46)
- "In the Foker technique, the surgeon ties sutures to either end of the esophagus through an open incision, brings them out through the chest wall, ties them together in a knot, and places spacers underneath periodically (about every day) until the ends come together for primary anastomosis." — Rod Gerardo (host_summary) [Ep 7 · 1:08](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=68)
- "Stretch is a very strong promoter of growth, and if you put things on tension they will actually grow over time, which is how the cardiovascular system develops in utero." — Daniel von Allmen (clinical) [Ep 7 · 2:10](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130)
- "The philosophy of traction-based elongation is that with traction, you can get the two ends of the esophagus to grow, and if you can get them to grow far enough, you can put them together." — Daniel von Allmen (clinical) [Ep 7 · 2:10](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130)
- "The van der Zee technique uses the same concept as Foker but is done thoracoscopically with no external sutures, so all tension is inside the thorax." — Rod Gerardo (host_summary) [Ep 7 · 2:39](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=159)
- "The Kimura technique involves creating a spit fistula and periodically moving it down the chest wall over time to stretch the proximal pouch closer to the distal pouch, but is not used all that often anymore." — Rod Gerardo (host_summary) [Ep 7 · 2:39](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=159)
- "In the Boston Group 2015 study, the primary group (de novo cases) achieved an intact esophagus in 96% of patients, while the secondary group (patients with previous operations) achieved this in about two thirds of patients." — Daniel von Allmen (host_summary) [Ep 7 · 3:15](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "In the Boston Group 2015 study, the primary group had a median ICU stay of 70 days with a couple of weeks being paralyzed, and the secondary group had a median ICU stay of 110 days with a month of being paralyzed." — Daniel von Allmen (host_summary) [Ep 7 · 3:15](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "In the Boston Group 2015 study, about two thirds of patients with primary repair were able to get full oral nutrition and about 10% of patients who had secondary repair achieved full oral nutrition." — Daniel von Allmen (host_summary) [Ep 7 · 3:15](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "The surgical group from INOEA recommends gastric pull up as the first option for esophageal replacement, dividing the esophageal stump at the esophageal hiatus and mobilizing the fundus to pull it up in either the anterior or posterior mediastinum." — Daniel von Allmen (host_summary) [Ep 7 · 4:36](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276)
- "The colon can be used as an interposition for esophageal replacement." — Daniel von Allmen (clinical) [Ep 7 · 4:36](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276)
- "In colonic interposition, the piece of colon chosen is based on the blood supply and the diameter needed." — Rod Gerardo (host_summary) [Ep 7 · 5:08](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308)
- "In colonic interposition, a pyloroplasty is performed to help with gastric emptying." — Rod Gerardo (host_summary) [Ep 7 · 5:08](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308)
- "Common problems with colonic interposition are that the colon can dilate and become tortuous, and it's not uncommon to get a sigmoid sink drain deformity just above the diaphragm." — Daniel von Allmen (clinical) [Ep 7 · 8:00](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=480)
- "Von Allman was initially taught that sigmoid redundancy in colonic interposition can't be fixed and that it's too dangerous because it will risk the blood supply, but he found that this is not really true." — Daniel von Allmen (opinion) [Ep 7 · 8:17](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "Von Allman passes the colonic interposition posterior to the stomach, which leaves the vascular pedicle along the spine, allowing mobilization of the colon by dividing the gastric duodenotomy and colon attachment to the stomach, then mobilizing the sigmoid redundancy transhiatally and reanastomosing the colon to the stomach." — Daniel von Allmen (clinical) [Ep 7 · 8:17](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "Colonic interpositions sometimes need to be revised, but it is not impossible to revise them and the kids tend to do pretty well." — Daniel von Allmen (opinion) [Ep 7 · 8:17](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "You can get extraordinary length with colonic interposition, allowing treatment of cases with caustic injuries extending to the pharynx by sewing the colon to the pharynx and down to the stomach, which is tough to do with a gastric pull-up." — Daniel von Allmen (clinical) [Ep 7 · 9:03](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=543)
- "The short interval between time of traction and anastomosis (less than five days) raises the question of whether the mechanism is stretching or growth, which will impact results and likely reflects on complications." — Rod Gerardo (host_summary) [Ep 7 · 9:27](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=567)
- "Von Allman states we don't know whether esophageal elongation is growth or stretch and should do studies to understand that, but notes that tension is a very good physiologic growth promoter in other organs, making this an area ripe for more basic science." — Daniel von Allmen (opinion) [Ep 7 · 9:56](https://qa.library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=596)
- "The azygous vein drains the bronchi, trachea, and esophagus, and its division may lead to impaired function postoperatively and impaired clearance of mucus and debris from the tracheobronchial tree" — Jose Campos (host_summary) [Ep 8 · 3:25](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=205)
- "In a meta-analysis of almost 700 neonates, preserving the azygous vein resulted in significantly lower postoperative pneumonitis compared to division" — Ellen Encisco (host_summary) [Ep 8 · 3:02](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=182)
- "There was no significant difference in anastomotic leak rate or stricture rate between azygous vein preservation and division" — Ellen Encisco (host_summary) [Ep 8 · 3:11](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=191)
- "The endpoint of chest infection in the azygous vein meta-analysis was not clearly defined across studies—some used 'chest infection,' some 'pneumonitis,' some 'pneumonia'—making it a non-homogeneous endpoint" — Jose Campos (clinical) [Ep 8 · 4:45](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=285)
- "In the Quebec study of 244 patients, the overall anastomotic stricture rate at one year was 30%" — Ellen Encisco (host_summary) [Ep 8 · 6:43](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=403)
- "36% of patients with transanastomotic tubes developed strictures compared to 19% without tubes, a difference that remained significant after multivariable analysis" — Ellen Encisco (host_summary) [Ep 8 · 6:50](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=410)
- "Patients with transanastomotic tubes had 2.72 times higher odds of developing a stricture compared to those without" — Ellen Encisco (host_summary) [Ep 8 · 7:06](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=426)
- "The Quebec study adjusted for gestational age, leak, length of gap, and tension, and still found almost 3 times higher stricture rates with transanastomotic tubes" — Jose Campos (host_summary) [Ep 8 · 7:32](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=452)
- "Patients with transanastomotic tubes started feeding on day 2 versus day 10 for those without tubes, but early feeding did not lead to less TPN—duration was 9 days in both groups" — Em Gootee (host_summary) [Ep 8 · 7:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=474)
- "Congenital esophageal stenosis is associated with esophageal atresia in 7% to 10% of cases and most are diagnosed really late, sometimes after the anastomosis fails" — Jose Campos (epidemiological) [Ep 8 · 9:44](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=584)
- "Passing a tube through the anastomosis to check for resistance can help identify distal esophageal stenosis intraoperatively" — Jose Campos (clinical) [Ep 8 · 9:58](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=598)
- "In a meta-analysis of about 500 newborns, there was no significant difference in leak occurrence, pneumothorax, or mortality based on whether a chest drain was placed" — Em Gootee (host_summary) [Ep 8 · 12:20](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=740)
- "The group that received a chest drain had a significantly higher chance of returning to the operating room" — Em Gootee (host_summary) [Ep 8 · 12:31](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=751)
- "If a leak occurs, it doesn't always drain through the chest tube" — Todd Ponsky (clinical) [Ep 8 · 11:23](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=683)
- "A chest tube may injure, suck on, or increase the chance of disruption of the anastomosis" — Todd Ponsky (opinion) [Ep 8 · 11:30](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=690)
- "Chest tubes are painful for patients" — Todd Ponsky (clinical) [Ep 8 · 11:39](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=699)
- "Giving acid suppression to neonates increases the risk of necrotizing enterocolitis according to neonatologists' concerns" — Todd Ponsky (host_summary) [Ep 8 · 13:41](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=821)
- "Giving PPIs to neonates can increase pneumonia in different populations, but the risk is very minimal" — Jose Campos (clinical) [Ep 8 · 14:24](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=864)
- "In the Midwest Pediatric Surgery Consortium study, antibiotics for more than 24 hours and acid suppression showed no difference in strictures or leaks" — Ellen Encisco (host_summary) [Ep 8 · 14:54](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=894)
- "Not giving antibiotics postoperatively helps detect complications early rather than having antibiotics cover a complication" — Jose Campos (clinical) [Ep 8 · 14:10](https://qa.library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=850)
- "The green telepresence system from Stanford Research Institute was originally designed as an open surgical platform, not for minimally invasive surgery." — Marc Michalsky (clinical) [Ep 12 · 7:56](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=476)
- "Colonel Rick Satava had an 'aha moment' after seeing Jacques Marescaux's laparoscopic cholecystectomy video, leading him to propose marrying robotic and laparoscopic technologies." — Marc Michalsky (clinical) [Ep 12 · 8:34](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=514)
- "Computer Motion's 5mm instruments were sunsetted by Intuitive after acquisition, creating a persistent gap for pediatric applications." — Marc Michalsky (clinical) [Ep 12 · 13:09](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=789)
- "The transition from da Vinci SI to XI was transformational, creating much more flexible range of motion." — Marc Michalsky (clinical) [Ep 12 · 12:20](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=740)
- "One large children's hospital acquired a robot without planning; it sat unused for 18 months costing $25,000/month in maintenance." — Marc Michalsky (clinical) [Ep 12 · 22:12](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=1332)
- "Nationwide formed a steering committee with pediatric surgery, urology, anesthesia, nursing, and periop administration to develop integrated multidisciplinary program." — Marc Michalsky (clinical) [Ep 12 · 23:14](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=1394)
- "Robotic cases garner a higher facility charge (level 5, ~$4000 per 15 minutes) versus laparoscopic cases (level 3, ~$2200 per 15 minutes)." — Marc Michalsky (clinical) [Ep 12 · 60:27](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3627)
- "Nationwide has seen no insurance denials for robotic pre-certification and no patient reports of astronomical bills or surcharges attributed to robot use." — Marc Michalsky (clinical) [Ep 12 · 61:21](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3681)
- "Maintenance of certification requires at least 10 robotic cases over a 2-year credentialing cycle plus mandatory quarterly digital simulation." — Marc Michalsky (guideline) [Ep 12 · 30:19](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=1819)
- "Block time overlay system assigns automated robot availability on top of surgeons' existing block time, with 14-day release mechanism if unused." — Marc Michalsky (clinical) [Ep 12 · 32:20](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=1940)
- "Using longer 'bariatric' instruments spreads out the robot above the patient and reduces likelihood of external arm collisions, even in smaller children." — Marc Michalsky (clinical) [Ep 12 · 34:36](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2076)
- "In Nationwide's experience of ~1000 patients, 12% of robotic cases were performed on patients less than 15kg, primarily driven by urology." — Marc Michalsky (epidemiological) [Ep 12 · 35:29](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2129)
- "No difference in operating time, 30-day complications, or readmissions for sleeve gastrectomy above versus below BMI 50." — Marc Michalsky (clinical) [Ep 12 · 36:43](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2203)
- "Learning curve for robotic sleeve gastrectomy decreased from 132 minutes with SI to 36 minutes with XI; speaker has performed cases in 21 minutes." — Marc Michalsky (clinical) [Ep 12 · 41:44](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2504)
- "Robotic sleeve gastrectomy initially took 30 minutes longer than laparoscopic but patients were discharged earlier." — Marc Michalsky (clinical) [Ep 12 · 41:07](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2467)
- "No difference in time or complications for robotic acute cholecystitis versus elective cholecystectomy." — Marc Michalsky (clinical) [Ep 12 · 43:51](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2631)
- "Robotic surgery experience has made the speaker a better laparoscopic surgeon, particularly for intracorporeal knot tying." — Marc Michalsky (opinion) [Ep 12 · 44:29](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2669)
- "Intuitive has 4 pediatric surgeons working for it, including James Wall, all with Stanford/Palo Alto connections." — Marc Michalsky (clinical) [Ep 12 · 58:25](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3505)
- "Intuitive is working with FDA to reconfigure clearance from specific case indications to categories, which will include pediatrics." — Marc Michalsky (clinical) [Ep 12 · 58:25](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3505)
- "Carl Storz platform has 5mm instrumentation and strong interest in pediatric applications." — Marc Michalsky (clinical) [Ep 12 · 59:07](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3547)
- "Intuitive will not build a pediatric-specific robot as it would require ~$1 billion investment without adequate ROI." — Marc Michalsky (opinion) [Ep 12 · 59:17](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3557)
- "Fellow credentialing requires 10 bedside assists and 20 console cases as primary surgeon, plus skills/drills and certificate completion." — Marc Michalsky (guideline) [Ep 12 · 62:42](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3762)
- "Hopkins performed a robotic cholecystectomy in a pig cadaver model with effectively no human input earlier this summer." — Marc Michalsky (clinical) [Ep 12 · 55:30](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3330)
- "J&J has partnership with Google for metadata power to develop digital overlay systems incorporating axial imaging into robotic view." — Marc Michalsky (clinical) [Ep 12 · 64:45](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=3885)
- "Dr. Clatworthy was the first pediatric surgeon in Ohio, trained by Dr. Gross at Boston Children's, and became first surgeon-in-chief at Columbus Children's Hospital." — Marc Michalsky (host_summary) [Ep 12 · 4:32](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=272)
- "Teen-LABS data at 10 years shows effectively no difference in outcomes between Roux-en-Y gastric bypass and sleeve gastrectomy." — Marc Michalsky (host_summary) [Ep 12 · 39:10](https://qa.library.globalcastmd.com/watch/dr-marc-michalsky-pediatric-robotic-assisted-surgery-developing-a-programmatic-paradigm-11169?t=2350)
- "EA/TEF is a basic concept in pediatric surgery." — Jill Knepprath (opinion) [Ep 13 · 0:05](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=5)
- "In normal anatomy, the esophagus goes straight down to the stomach with no atresia or interruptions, and the trachea goes straight down to the lungs with no connections between the two." — Jill Knepprath (clinical) [Ep 13 · 0:10](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=10)
- "Type A EA/TEF consists of esophageal atresia proximally and distally in the esophagus, preventing solids and liquids from reaching the stomach, with no connection between esophagus and trachea." — Jill Knepprath (clinical) [Ep 13 · 0:29](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=29)
- "Type B EA/TEF has distal esophageal atresia and a proximal fistula, allowing solids and liquids to enter the trachea while the stomach remains empty." — Jill Knepprath (clinical) [Ep 13 · 0:45](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=45)
- "Type C EA/TEF is the most common type." — Jill Knepprath (epidemiological) [Ep 13 · 1:08](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=68)
- "Type C EA/TEF has proximal esophageal atresia and a distal fistula, allowing air to reach both lungs and stomach while solids and liquids cannot reach the stomach." — Jill Knepprath (clinical) [Ep 13 · 1:13](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=73)
- "Type D EA/TEF has both a distal fistula and a proximal fistula, allowing solids and liquids into the trachea and air into both lungs and stomach." — Jill Knepprath (clinical) [Ep 13 · 1:28](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=88)
- "Type E EA/TEF has no atresia but does have a tracheoesophageal fistula, which is often pretty high." — Jill Knepprath (clinical) [Ep 13 · 1:43](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=103)
- "Type E EA/TEF is also known as H-type because of its anatomical appearance." — Jill Knepprath (clinical) [Ep 13 · 1:52](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=112)
- "Type E (H-type) EA/TEF has the best results and is usually the easiest to fix." — Jill Knepprath (clinical) [Ep 13 · 1:56](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=116)
- "Children with Type E (H-type) EA/TEF may present with symptoms later because they are still able to get solids and liquids down to the stomach and air to the lungs." — Jill Knepprath (clinical) [Ep 13 · 2:01](https://qa.library.globalcastmd.com/watch/esophageal-atresia-tracheoesophageal-fistula-types-explained-for-pediatric-surgery-14001?t=121)
- "TEF is a defining procedure of pediatric surgery with challenges including long gap atresia, recurrent fistulas, and strictures" (host_summary) [Ep 6 · 0:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=0)
- "Cincinnati Children's has a multidisciplinary aerodigestive center including ENT airway surgeons, GI, pulmonary, general surgeons, nurse practitioners, geneticists, and dietitians" — Daniel von Allmen (clinical) [Ep 6 · 2:01](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=121)
- "The aerodigestive center typically receives more complicated patients referred from outside through either esophageal or airway arms" — Daniel von Allmen (clinical) [Ep 6 · 2:46](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=166)
- "Physical examination should assess for scaphoid versus full or distended abdomen and respiratory distress" — Daniel von Allmen (clinical) [Ep 6 · 3:55](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=235)
- "The surgeon should personally attempt to pass the NG tube rather than relying on nursing reports, as tubes reported as not passing sometimes pass easily" — Daniel von Allmen (clinical) [Ep 6 · 4:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=260)
- "Injecting air into the NG tube and obtaining a plain film helps visualize proximal pouch distention and assess distal GI gas pattern" — Daniel von Allmen (clinical) [Ep 6 · 4:55](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=295)
- "Lack of visible distended proximal pouch raises concern for either incorrect diagnosis or presence of proximal fistula allowing pouch decompression" — Daniel von Allmen (clinical) [Ep 6 · 5:01](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=301)
- "Contrast studies can be performed if there is high suspicion of unusual anatomy, as long as the radiologist knows the esophagus may be obstructed" — Daniel von Allmen (clinical) [Ep 6 · 5:42](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=342)
- "Echocardiogram is the most important preoperative study to assess cardiac anatomy and rule out right-sided aortic arch" — Daniel von Allmen (clinical) [Ep 6 · 6:25](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=385)
- "Renal ultrasound and spine evaluation for tethered cord are needed but are elective and not necessary before addressing esophageal atresia" — Daniel von Allmen (clinical) [Ep 6 · 6:54](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=414)
- "Conventional wisdom is to perform left thoracotomy for right-sided aortic arch" — Daniel von Allmen (guideline) [Ep 6 · 7:27](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=447)
- "Left thoracotomy for right-sided arch is somewhat more difficult with the heart more in the way and harder proximal pouch mobilization" — Daniel von Allmen (clinical) [Ep 6 · 7:51](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=471)
- "It is possible to complete the repair from the right side if right-sided arch is discovered intraoperatively, though some reports suggest higher incidence of swallowing problems" — Daniel von Allmen (clinical) [Ep 6 · 8:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=500)
- "In a stable larger baby not intubated, it is reasonable to wait until all resources are available in the middle of the day, even waiting 1-2 days" — Daniel von Allmen (clinical) [Ep 6 · 9:31](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=571)
- "Should not wait a long time before repair due to risk of colonizing GI tract and soiling lungs" — Daniel von Allmen (clinical) [Ep 6 · 9:56](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=596)
- "Oscillator ventilation does not make a significant difference in managing large fistulas with abdominal distention" — Daniel von Allmen (opinion) [Ep 6 · 10:15](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=615)
- "Large fistula with distention tends to be a bigger problem in more premature infants with significant lung disease, where poor lung compliance drives air into GI tract" — Daniel von Allmen (clinical) [Ep 6 · 10:15](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=615)
- "Treating with surfactant and improving lung compliance helps as much as changing ventilator type" — Daniel von Allmen (clinical) [Ep 6 · 10:56](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=656)
- "Risk of waiting too long to make a decision in worsening distention can lead to emergency situation where child cannot be ventilated" — Daniel von Allmen (clinical) [Ep 6 · 11:21](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=681)
- "For reasonably stable but worsening distention, would take child urgently to OR for right thoracotomy and fistula ligation" — Daniel von Allmen (clinical) [Ep 6 · 12:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=720)
- "Bronchoscopic Fogarty balloon placement sounds good but is difficult unless expertise and equipment are immediately available" — Daniel von Allmen (opinion) [Ep 6 · 12:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=720)
- "G-tube decompression may paradoxically worsen ventilation by making stomach lower resistance, allowing more air to go there instead of lungs" — Daniel von Allmen (clinical) [Ep 6 · 12:00](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=720)
- "Laparotomy with vessel loop around esophagogastric junction at hiatus with gentle traction (Rommel tourniquet technique) can temporize severe cases, leaving in place for several days before definitive repair" — Daniel von Allmen (clinical) [Ep 6 · 12:50](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=770)
- "For associated duodenal atresia in stable child, would potentially fix duodenal atresia first to avoid fixing esophagus upstream from obstruction" — Daniel von Allmen (clinical) [Ep 6 · 13:36](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=816)
- "Both duodenal and esophageal atresia could potentially be fixed at same time if child is old enough and stable enough" — Daniel von Allmen (clinical) [Ep 6 · 14:05](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=845)
- "Von Allmen changed practice to always perform intraoperative bronchoscopy after exposure to Cincinnati's complex patient population" — Daniel von Allmen (clinical) [Ep 6 · 14:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=875)
- "Bronchoscopy documents fistula location, assesses for proximal fistula, and most importantly rules out laryngeal cleft which is easily missed" — Daniel von Allmen (clinical) [Ep 6 · 14:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=875)
- "Many referred patients with multiple thoracotomies never had bronchoscopy and actually have laryngeal cleft" — Daniel von Allmen (clinical) [Ep 6 · 14:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=875)
- "Second fistula occurs in approximately 1% of cases and can be very difficult to diagnose" — Daniel von Allmen (epidemiological) [Ep 6 · 15:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=935)
- "High fistulas can range from trifurcation of carina (suggesting difficulty getting ends together) to very high fistulas potentially approachable through neck" — Daniel von Allmen (clinical) [Ep 6 · 15:52](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=952)
- "Bronchoscopy allows guidance of ET tube placement by anesthesiologist based on fistula location" — Daniel von Allmen (clinical) [Ep 6 · 16:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=995)
- "For fistula at carina (trifurcation), ET tube should be placed higher as it cannot pass the fistula; for high fistula, tube should be placed distal to fistula but not into the fistula itself" — Daniel von Allmen (clinical) [Ep 6 · 16:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=995)
- "Extrapleural approach offers advantage of potentially limiting soilage of pleural space if there is postoperative leak" — Daniel von Allmen (clinical) [Ep 6 · 17:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1039)
- "Dividing azygos has no morbidity, gives better access, and frequently guides to the fistula" — Daniel von Allmen (clinical) [Ep 6 · 17:41](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1061)
- "Open azygos division is done by ligation and division; thoracoscopically can use energy devices or clips" — Daniel von Allmen (clinical) [Ep 6 · 17:59](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1079)
- "Hook cautery can safely divide vessels if done slowly going up and down to ensure coagulation, learned from robotic Nissen experience dividing short gastrics" — Daniel von Allmen (clinical) [Ep 6 · 18:51](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1131)
- "3mm surgical sealer is ideal device for this size patient and vessel" — Daniel von Allmen (opinion) [Ep 6 · 18:51](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1131)
- "Spreading heel of right angle on ribs nicely shows extrapleural plane when going through intercostal muscles" — Daniel von Allmen (clinical) [Ep 6 · 19:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1175)
- "Important to mobilize pleura up around apex of lung to have access for proximal pouch mobilization" — Daniel von Allmen (clinical) [Ep 6 · 19:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1175)
- "After azygos division, identify distal esophagus and control with vessel loop, then dissect proximally to identify fistula site" — Daniel von Allmen (clinical) [Ep 6 · 19:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1175)
- "Muscle-sparing thoracotomy can make exposure more difficult; has not seen significant morbidity from standard posterolateral thoracotomy" — Daniel von Allmen (opinion) [Ep 6 · 20:28](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1228)
- "Standard teaching has been not to mobilize distal esophagus, but can actually mobilize it significantly especially laterally all the way to diaphragm" — Daniel von Allmen (clinical) [Ep 6 · 21:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1270)
- "Must be careful with medial mobilization of distal esophagus due to blood supply concerns" — Daniel von Allmen (clinical) [Ep 6 · 21:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1270)
- "Extensive proximal pouch mobilization gives the most length to get ends together" — Daniel von Allmen (clinical) [Ep 6 · 21:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1270)
- "Thoracoscopic approach advantage is clearer visualization for proximal pouch mobilization" — Daniel von Allmen (opinion) [Ep 6 · 21:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1270)
- "Proximal pouch dissection is similar to separating rectum and vagina - making two planes out of one without great natural separation" — Todd Ponsky (clinical) [Ep 6 · 22:03](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1323)
- "Risk of entering trachea during proximal dissection; must be very careful using blade cautery with light buzz and mostly blunt dissection with flat end of blade" — Daniel von Allmen (clinical) [Ep 6 · 22:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1340)
- "Better to be in esophagus than trachea during high chest dissection; esophagus is thickened from obstruction" — Daniel von Allmen (clinical) [Ep 6 · 22:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1340)
- "For significant tracheal defect, could perform sleeve resection as trachea is incredibly mobile, then place pericardium or autologous tissue between trachea and esophageal repair" — Daniel von Allmen (clinical) [Ep 6 · 23:01](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1381)
- "Personal preference is 5-0 PDS - absorbable monofilament suture; not a fan of silk" — Daniel von Allmen (opinion) [Ep 6 · 23:59](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1439)
- "Not a fan of myotomies as they potentially create even more dysfunctional esophageal segment; motility is already clearly abnormal in esophageal atresia" — Daniel von Allmen (opinion) [Ep 6 · 24:42](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1482)
- "For cases too tight for primary repair, would ligate ends, tack both on tension to prevertebral fascia, close, let patient grow for couple weeks, then return to put together" — Daniel von Allmen (clinical) [Ep 6 · 24:42](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1482)
- "Traction or pressure is very strong stimulus to growth throughout cardiovascular system and lungs" — Daniel von Allmen (clinical) [Ep 6 · 25:38](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1538)
- "For thoracoscopic approach, can place traction sutures in proximal and distal ends brought out through crossed trocar sites with tension, allowing return within a week for anastomosis" — Daniel von Allmen (clinical) [Ep 6 · 26:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1570)
- "Would not do classic Foker technique with prolonged paralysis and sequential suture tensioning" — Daniel von Allmen (opinion) [Ep 6 · 26:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1570)
- "Rusty Jennings and Foker published series in JPS showing 98% success getting ends together in primary atresia versus only 67% in secondary approaches after previous surgeries" — Daniel von Allmen (epidemiological) [Ep 6 · 27:38](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1658)
- "Foker technique requires patients intubated and paralyzed spending weeks in ICU, which is probably worth it if you get good result" — Daniel von Allmen (clinical) [Ep 6 · 27:38](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1658)
- "For thoracoscopic procedure, rotate patient past 90 degrees to allow gravity to move lungs out of way" — Daniel von Allmen (clinical) [Ep 6 · 29:18](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1758)
- "Standard port placement: camera in center, posterior port inferiorly, anterior port superiorly" — Daniel von Allmen (clinical) [Ep 6 · 29:18](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1758)
- "Uses 3mm instruments for thoracoscopic TEF repair" — Daniel von Allmen (clinical) [Ep 6 · 29:52](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1792)
- "Important to do same quality operation thoracoscopically as would do open" — Daniel von Allmen (opinion) [Ep 6 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Sewing the anastomosis is one of the challenges with thoracoscopic TEF repair and requires most experience with minimally invasive techniques" — Daniel von Allmen (clinical) [Ep 6 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Would use clips for dividing fistula thoracoscopically, less worried about them falling off esophagus than blood vessel" — Daniel von Allmen (opinion) [Ep 6 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Thoracoscopic visualization is very helpful for mobilizing proximal pouch" — Daniel von Allmen (opinion) [Ep 6 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Simulation courses for TEF repair will be great advantage for trainees as these cases are not done often enough to get practice" — Daniel von Allmen (opinion) [Ep 6 · 30:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1810)
- "Marcelo Martinez Ferro's 'spaghetti trick' - grabbing and twirling tip of proximal pouch shows the dissection plane nicely" — Todd Ponsky (clinical) [Ep 6 · 31:21](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1881)
- "Atlanta group uses stay stitch between two ends brought out of chest to hold anastomosis up for subsequent stitches, similar to duodenal atresia technique" — Daniel von Allmen (host_summary) [Ep 6 · 31:37](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1897)
- "Vicryl ties down nice and tight but cannot use knot pusher for first stitch under tension as it will tear through esophagus; need monofilament for extracorporeal knots" — Todd Ponsky (clinical) [Ep 6 · 32:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1930)
- "Braided suture is safe for all intracorporeal technique" — Todd Ponsky (clinical) [Ep 6 · 32:10](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1930)
- "After clipping fistula, do not divide it completely until ready to place first stitch so distal esophagus doesn't drop toward diaphragm" — Todd Ponsky (clinical) [Ep 6 · 32:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=1965)
- "Hanging stitch helps let go of some tension as first couple stitches are placed, providing some degree of approximation before throwing down first stitches" — Avi Schlager (clinical) [Ep 6 · 33:21](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2001)
- "Must be able to see and incorporate mucosa on every stitch; hanging stitch helps visualize lumen of both proximal and distal ends" — Todd Ponsky (clinical) [Ep 6 · 33:54](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2034)
- "Thoracoscopic ventilation management depends more on anesthesiologist than ventilator type; need anesthesiologist comfortable with procedure who pays attention during operation" — Daniel von Allmen (clinical) [Ep 6 · 34:30](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2070)
- "Can position ET tube after bronchoscopy to selectively ventilate left lung" — Todd Ponsky (clinical) [Ep 6 · 34:48](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2088)
- "Little CO2 insufflation with some time will collapse lung as long as anesthesiologist isn't fighting with positive pressure" — Daniel von Allmen (clinical) [Ep 6 · 35:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2120)
- "Anesthesiologists can get scared seeing initial shunting but things settle down if they wait" — Daniel von Allmen (clinical) [Ep 6 · 35:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2120)
- "Concern about reintubation exists, but equally concerned that positive pressure puts pressure on tracheal repair" — Daniel von Allmen (clinical) [Ep 6 · 36:05](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2165)
- "Prefer spontaneous breathing with negative pressure in trachea rather than positive pressure" — Daniel von Allmen (opinion) [Ep 6 · 36:05](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2165)
- "If patient had good lung function preoperatively and operation went smoothly, advocate extubating as soon as possible, even conceivably in operating room" — Daniel von Allmen (clinical) [Ep 6 · 36:05](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2165)
- "Gets contrast study at 5-7 days before pulling chest drain, timing depends on avoiding weekends" — Daniel von Allmen (clinical) [Ep 6 · 36:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2195)
- "Uses small TLS drain rather than formal chest tube, especially for open extrapleural approach" — Daniel von Allmen (clinical) [Ep 6 · 36:35](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2195)
- "Does not use transanastomotic tube based on Midwest Pediatric Surgical Consortium study showing much higher stricture and leak rate with transanastomotic tubes" — Daniel von Allmen (clinical) [Ep 6 · 37:20](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2240)
- "Midwest consortium study was presented at APSA and should be published in JPS soon" — Daniel von Allmen (clinical) [Ep 6 · 37:37](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2257)
- "Unless incredibly tight stricture risking complete obstruction, would wait several weeks before first dilation" — Daniel von Allmen (clinical) [Ep 6 · 37:55](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2275)
- "Always appears to be narrowing at anastomosis because proximal pouch is dilated; as long as patent with free contrast flow distally, would hold off on dilation" — Daniel von Allmen (clinical) [Ep 6 · 37:55](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2275)
- "Fairly aggressive with dilations: dilate, wait 1-2 weeks, restudy, potentially dilate again" — Daniel von Allmen (clinical) [Ep 6 · 38:23](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2303)
- "Huge spectrum from very tight strictures requiring many dilations to kids fine after one dilation" — Daniel von Allmen (clinical) [Ep 6 · 38:23](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2303)
- "If case goes well and post-op study looks great, does not get routine follow-up esophagrams; studies based on clinical symptoms suggesting stricture" — Daniel von Allmen (clinical) [Ep 6 · 38:23](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2303)
- "Balloon or radial dilation is less traumatic for tissue than bougie dilators" — Daniel von Allmen (clinical) [Ep 6 · 39:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2359)
- "Dilations done with GI colleagues in aerodigestive center for bigger kids or with interventional radiologists" — Daniel von Allmen (clinical) [Ep 6 · 39:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2359)
- "For small leak with child not sick, would absolutely wait and do nothing, leaving drain in; vast majority close" — Daniel von Allmen (clinical) [Ep 6 · 39:51](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2391)
- "Leak increases risk of postoperative stricture" — Todd Ponsky (clinical) [Ep 6 · 40:04](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2404)
- "Would only go to OR for leak if child getting sicker, wide open leak, or large uncontrollable pneumothorax" — Daniel von Allmen (clinical) [Ep 6 · 40:09](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2409)
- "Even reasonably significant leaks will heal, then can deal with stricture postoperatively" — Daniel von Allmen (clinical) [Ep 6 · 40:09](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2409)
- "Usually waits one week between esophagrams for leak; if child continues to do well, restudies" — Daniel von Allmen (clinical) [Ep 6 · 40:34](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2434)
- "Sometimes little outpouching where leak happened makes it unclear if still leaking; if nothing from tube and nothing goes further, leak probably healed and would remove tube" — Daniel von Allmen (clinical) [Ep 6 · 40:34](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2434)
- "Pediatric surgeons don't do fantastic job of long-term follow-up with TEF patients" — Todd Ponsky (opinion) [Ep 6 · 41:09](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2469)
- "International esophageal atresia meeting occurs every 2 years and is multidisciplinary including patients" — Daniel von Allmen (clinical) [Ep 6 · 41:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2479)
- "Patients in their 20s-40s at international meeting discuss long-term issues; surgeons tend to follow until eating well or age 18 then never see them again" — Daniel von Allmen (clinical) [Ep 6 · 41:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2479)
- "Have a lot to learn about long-term complications; personally follows patients for at least couple years which is probably not long enough" — Daniel von Allmen (opinion) [Ep 6 · 41:19](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2479)
- "Biggest challenges in long-term follow-up are reflux and recurrent strictures" — Daniel von Allmen (clinical) [Ep 6 · 42:15](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2535)
- "More concerning are patients with ongoing reflux due to unknown long-term impact on Barrett's esophagus and potential malignant change" — Daniel von Allmen (clinical) [Ep 6 · 42:15](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2535)
- "If patient has stricture dilated 2-3 times, next move would be to address reflux" — Daniel von Allmen (clinical) [Ep 6 · 42:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2565)
- "Most patients left on anti-reflux medications when discharged from hospital" — Daniel von Allmen (clinical) [Ep 6 · 42:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2565)
- "Virtually all patients have some degree of gastroesophageal reflux" — Daniel von Allmen (clinical) [Ep 6 · 42:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2565)
- "Very aggressive about fundoplication for strictures not responsive to dilations (dilates easily then restrictures)" — Daniel von Allmen (clinical) [Ep 6 · 42:45](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2565)
- "Does Nissen fundoplication in patients with poor esophageal motility but makes them loose and short, using 2 or at most 3 stitches" — Daniel von Allmen (clinical) [Ep 6 · 43:26](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2606)
- "For pure esophageal atresia, approach is G-tube placement with calibration of gap length using distal catheter pushed up and NG tube in proximal pouch" — Daniel von Allmen (clinical) [Ep 6 · 43:26](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2606)
- "Would wait 4-6 weeks to see how close ends come together, then attempt primary repair once within 2 vertebral bodies" — Daniel von Allmen (clinical) [Ep 6 · 43:26](https://qa.library.globalcastmd.com/watch/tracheoesophageal-fistula-with-dr-daniel-von-allmen-300?t=2606)
- "The first successful open repair of tracheoesophageal fistula was performed in 1941 by Dr. Cameron Haight." — Alex Gibbons (host_summary) [Ep 1 · 1:24](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=84)
- "In the year 2000, Dr. Steven Rothenberg performed the first successful repair of a tracheoesophageal fistula with a minimally invasive approach (esophageal atresia had been the year before)." — Alex Gibbons (host_summary) [Ep 1 · 1:46](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=106)
- "In Rothenberg's first decade of experience with 62 patients, he reported that thoracoscopic approach offered better visualization of the anatomy." — Alex Gibbons (host_summary) [Ep 1 · 2:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=130)
- "Rothenberg reported that performing the operation entirely in situ reduced manipulation of the trachea and therefore potentially reduced risk for tracheomalacia." — Alex Gibbons (host_summary) [Ep 1 · 2:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=160)
- "Rothenberg reported decreased tension on the esophageal anastomosis with thoracoscopic approach." — Alex Gibbons (host_summary) [Ep 1 · 3:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=180)
- "Rothenberg reported that smaller incisions would result in fewer musculoskeletal deformities such as scapular winging, chest wall asymmetry, and scoliosis." — Alex Gibbons (host_summary) [Ep 1 · 3:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=190)
- "The Tübingen Germany single-center study found the minimally invasive group was slightly larger at about 2,700g compared to 2,100g in the open group." — Alex Gibbons (host_summary) [Ep 1 · 4:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=240)
- "The Tübingen study found slightly more associated anomalies in the minimally invasive group at about 40% compared to 31% in the open group." — Alex Gibbons (host_summary) [Ep 1 · 4:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=270)
- "The Tübingen study found no statistically significant difference between groups in complication rate or time to postoperative extubation." — Alex Gibbons (host_summary) [Ep 1 · 5:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=300)
- "The Tübingen study found operative time was slightly longer at about half an hour longer in the minimally invasive group than in the open group." — Alex Gibbons (host_summary) [Ep 1 · 5:15](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=315)
- "The Tübingen study found higher intraoperative PaCO2 in the MIS group, but postoperatively there was no statistically significant difference." — Alex Gibbons (host_summary) [Ep 1 · 5:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=330)
- "The Holcomb multi-center study included 6 hospitals (Stanford California, Kansas City Missouri, Denver Colorado, Buenos Aires Argentina, Utrecht Netherlands, and Hong Kong China) with 104 total patients." — Alex Gibbons (host_summary) [Ep 1 · 5:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=350)
- "The Holcomb study found results equivalent to historical open controls in mortality rate and need for postoperative fundoplication." — Alex Gibbons (host_summary) [Ep 1 · 6:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=390)
- "The Holcomb study found results compared favorably to historical controls in terms of leak and recurrence." — Alex Gibbons (host_summary) [Ep 1 · 6:45](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=405)
- "The Japanese multi-center study of 7 hospitals with 58 patients found equivalence in mortality, leak rate, and recurrence between MIS and open approaches." — Alex Gibbons (host_summary) [Ep 1 · 7:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=450)
- "The Japanese study found a higher stricture rate in the minimally invasive group at about 48% compared to 17% in the open group." — Alex Gibbons (host_summary) [Ep 1 · 7:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=470)
- "The Hanover Germany study of patients who had minimally invasive or open thoracic procedures for benign conditions found improved rate of mild scoliosis in MIS group: over 50% in thoracotomy group compared to less than 10% in minimally invasive group." — Alex Gibbons (host_summary) [Ep 1 · 9:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=540)
- "The Hanover study found patients were more satisfied with scarring in the MIS group based on Manchester scarring criteria." — Alex Gibbons (host_summary) [Ep 1 · 9:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=570)
- "The Hanover study found chest wall asymmetry was improved in the minimally invasive group, specifically in chest wall diameter and distance of nipple to xiphoid." — Alex Gibbons (host_summary) [Ep 1 · 9:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=580)
- "The Hanover study found no difference in shoulder range of motion between MIS and open groups." — Alex Gibbons (host_summary) [Ep 1 · 9:55](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=595)
- "A 2012 meta-analysis of 4 articles representing 166 patients (69 MIS, 97 open) found no statistically significant difference in stricture rate, leak rate, operative time, or time to postoperative extubation." — Alex Gibbons (host_summary) [Ep 1 · 10:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=610)
- "A 2016 meta-analysis of 8 articles with 452 patients (221 MIS, 231 open) found no difference in stricture rate or leak rate." — Alex Gibbons (host_summary) [Ep 1 · 10:35](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=635)
- "The 2016 meta-analysis found operative time was about 20 minutes longer in the minimally invasive group." — Alex Gibbons (host_summary) [Ep 1 · 10:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=650)
- "The 2016 meta-analysis found time to postoperative extubation and first postoperative feeding were about 2.5 days sooner in the MIS group." — Alex Gibbons (host_summary) [Ep 1 · 11:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=660)
- "The 2016 meta-analysis found hospital length of stay was almost 11 days shorter in the MIS group." — Alex Gibbons (host_summary) [Ep 1 · 11:15](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=675)
- "A pilot randomized controlled trial at Children's Hospital London with 10 patients (randomized to MIS or open) found no difference in intraoperative PaCO2, pH, time in OR, peak inspiratory pressure, or length of ICU stay." — Alex Gibbons (host_summary) [Ep 1 · 11:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=690)
- "The London pilot RCT found 1 stricture in the open group compared to 3 strictures in the thoracoscopic group, and 1 leak in the thoracoscopic group compared to none in the open group." — Alex Gibbons (host_summary) [Ep 1 · 12:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=720)
- "The retrospective data suggest no difference in leak rate or stricture rate between thoracoscopic and open TEF repair." — Alex Gibbons (clinical) [Ep 1 · 12:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=750)
- "There is potential benefit with thoracoscopic approach in time to extubation, time to first oral feeding, overall hospital length of stay, and musculoskeletal sequelae." — Alex Gibbons (opinion) [Ep 1 · 12:45](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=765)
- "The chief limitation of thoracoscopic TEF repair is the technical demand, specifically the challenge of the anastomosis done in situ." — Alex Gibbons (opinion) [Ep 1 · 13:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=780)
- "There remains a need for a powered randomized controlled trial comparing thoracoscopic and open TEF repair." — Alex Gibbons (opinion) [Ep 1 · 13:15](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=795)
- "The primary reason for doing thoracoscopic TEF repair is eliminating the thoracotomy and its associated morbidity." — Steven Rothenberg (opinion) [Ep 1 · 12:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=760)
- "No matter what kind of thoracotomy is performed, there is morbidity associated with having a thoracotomy as an infant." — Steven Rothenberg (opinion) [Ep 1 · 12:55](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=775)
- "A recent study from the Midwest Consortium of approximately 10 hospitals showed less than 15% of TEF cases were done thoracoscopically in major US training centers." — Steven Rothenberg (host_summary) [Ep 1 · 14:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=870)
- "In US training programs, fellows who are not as experienced as staff are being trained to do the TEF operation, making them perhaps the least experienced person in the operating room." (opinion) [Ep 1 · 15:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=930)
- "In the multi-center report from 13-14 years ago, the surgeons were very experienced in MIS, which contributed to the good results (3 recurrences in 104 patients)." (opinion) [Ep 1 · 16:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=970)
- "Thoracoscopic TEF repair requires surgeons who are skilled in MIS to perform it and pass that skill on to trainees." — Steven Rothenberg (opinion) [Ep 1 · 16:33](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=993)
- "Rothenberg reports he has never had to resect a diverticulum after thoracoscopic TEF repair, whereas he has had to resect a number of diverticulums that were all done open." — Steven Rothenberg (clinical) [Ep 1 · 17:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=1070)
- "Thoracoscopically, the fistula is seen coming in directly at 90 degrees perpendicular, which is not seen when the operation is done open." — Steven Rothenberg (clinical) [Ep 1 · 18:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-tef-repair-is-it-really-better-than-open-update-course-2018-356?t=1090)
- "Less than half of esophageal atresia cases are detected antenatally, typically by small stomach and polyhydramnios." (epidemiological) [Ep 3 · 1:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=60)
- "Echocardiography is performed preoperatively to rule out congenital heart defects and determine aortic arch sidedness (right vs. left)." (clinical) [Ep 3 · 2:12](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=132)
- "VACTERL workup (renal ultrasound, vertebral X-rays, anorectal exam) can be completed electively after initial repair." (clinical) [Ep 3 · 2:31](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=151)
- "Right-sided aortic arch does not necessarily require left thoracotomy; multiple surgeons report successful repairs from the right side despite right arch." (clinical) [Ep 3 · 9:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=540)
- "Echocardiography may misidentify aortic arch sidedness; one surgeon encountered a double arch after echo reported right arch." (clinical) [Ep 3 · 10:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=600)
- "Preoperative bronchoscopy can identify double fistulas and predict gap length: fistula at mid-trachea suggests shorter gap, fistula at carina suggests longer gap." (clinical) [Ep 3 · 13:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=780)
- "For thoracoscopic repair, bronchoscopy helps the surgeon understand fistula location and anticipate gap distance." (clinical) [Ep 3 · 14:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=840)
- "Standard open approach uses right posterolateral thoracotomy, extrapleural dissection to vertebral bodies, with azygos vein as landmark for fistula location." (clinical) [Ep 3 · 17:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1020)
- "For uncomplicated EA, tissue interposition between trachea and esophagus is not routinely used because adequate tissue is difficult to find." (clinical) [Ep 3 · 17:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1050)
- "Chest tube is placed in extrapleural space on water seal (not suction) and removed after postoperative contrast study confirms no leak." (clinical) [Ep 3 · 18:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1080)
- "Retrospective study of ~100 patients found no difference in complications between Vicryl and silk suture for EA repair." (clinical) [Ep 3 · 21:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1260)
- "For thoracoscopic repair using knot-pusher technique, PDS must be used for the first stitch to avoid sawing through tissue; Vicryl can be used for intracorporeal ties." (clinical) [Ep 3 · 21:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1290)
- "Approximately 75% of EA/TEF patients are candidates for thoracoscopic repair; complicated congenital heart disease may preclude thoracoscopic approach due to longer operative time." (clinical) [Ep 3 · 23:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1380)
- "If the two esophageal ends cannot be approximated thoracoscopically, conversion to open is appropriate—surgeons get one good chance at primary repair." (opinion) [Ep 3 · 23:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1410)
- "Early thoracoscopic series (2008-2010) showed lower stricture rates with thoracoscopic vs. open repair, but more recent data show equivalent stricture rates." (host_summary) [Ep 3 · 25:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1500)
- "Babies under 2 kg are more difficult for thoracoscopic repair due to limited space for lung retraction and intracorporeal suturing." (clinical) [Ep 3 · 26:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1560)
- "In US training programs, fellows typically perform 4-8 EA repairs during fellowship, raising questions about adequate thoracoscopic training volume." (epidemiological) [Ep 3 · 27:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1620)
- "Average US attending surgeon performs 1-2 TEF repairs per year, making advanced thoracoscopic technique acquisition challenging." (host_summary) [Ep 3 · 27:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1650)
- "For thoracoscopic repair, ports should be spaced widely and staggered, with patient positioned more prone than lateral since esophagus is posterior mediastinal." (clinical) [Ep 3 · 29:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1740)
- "High-frequency oscillatory ventilation in the OR keeps the lung collapsed during thoracoscopic repair; disadvantage is the baby shaking, but hypercarbia is avoided." (clinical) [Ep 3 · 30:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1800)
- "Low-cost training models for EA repair are available and should be used at society meetings (IPEG, APSA) to address low case volume." (host_summary) [Ep 3 · 31:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1860)
- "Marcello reports doing all EA repairs thoracoscopically for over 10 years after performing ~150 open repairs, finding the approach natural and comfortable." (host_summary) [Ep 3 · 31:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1890)
- "Wet clips are a fast and reliable method for dividing the TEF during thoracoscopic repair." (host_summary) [Ep 3 · 32:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1920)
- "Yama's technique: divide only 3/4 of the fistula initially, leaving partial attachment as traction to facilitate anastomosis, then complete division." (host_summary) [Ep 3 · 33:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=1980)
- "C1 or TF needles (5-0 PDS) are preferred for thoracoscopic EA repair due to appropriate curve and ability to pass through 5-6mm trocars without tip damage." (clinical) [Ep 3 · 34:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2040)
- "Starting the anastomosis at the lateral (far) corner is most common; some start with a middle back-row stitch tied intracorporeally." (clinical) [Ep 3 · 34:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2070)
- "Passing a transanastomotic feeding tube after back-row sutures provides volume to help guide the needle through the anterior wall." (host_summary) [Ep 3 · 35:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2100)
- "The first anastomotic stitch does not need to be tied tight; subsequent stitches are tightened once approximation is confirmed." (clinical) [Ep 3 · 35:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2130)
- "Exteriorizing the first stitch through the chest wall with a hemostat can help bring the gap closer before placing subsequent sutures." (clinical) [Ep 3 · 36:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2160)
- "Minimal dissection of the distal esophagus preserves blood supply and reduces trauma, even in long-gap cases." (host_summary) [Ep 3 · 36:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2190)
- "For long-gap atresia (pure EA with gasless abdomen), G-tube placement allows gap assessment; if gap is ≤2 vertebral bodies, primary repair is attempted." (clinical) [Ep 3 · 37:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2250)
- "Interventional radiology can pass a wire and catheter up the distal esophagus via G-tube to define the gastroesophageal junction and measure gap accurately." (clinical) [Ep 3 · 38:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2280)
- "Cervical esophagostomy commits the patient to esophageal replacement; most surgeons avoid it and attempt delayed primary anastomosis." (opinion) [Ep 3 · 38:30](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2310)
- "For long-gap EA, waiting up to 3 months with G-tube feeds (advancing to bolus feeds to encourage distal esophageal growth) is reasonable before declaring the gap irreparable." (clinical) [Ep 3 · 39:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2340)
- "Routine bougienage of the proximal pouch does not reliably promote esophageal growth; growth occurs spontaneously over time." (opinion) [Ep 3 · 39:00](https://qa.library.globalcastmd.com/watch/esophageal-atresia-627?t=2340)
- "For thoracoscopic TEF repair, spk_0 assesses the gap between proximal and distal esophagus preoperatively using bronchoscopy (to identify the fistula orifice) followed by X-ray with the bronchoscope in place and a gastric tube, measuring the gap in vertebral body units." — Yama (clinical) [Ep 2 · 0:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=0)
- "In the presented case, the gap between proximal and distal esophagus was approximately one vertebral body." — Yama (clinical) [Ep 2 · 2:12](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=132)
- "The majority of surgeons divide the distal esophagus completely during TEF repair, but spk_0 leaves one quarter of the fistula uncut." — Yama (clinical) [Ep 2 · 2:31](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=151)
- "If the distal esophagus is divided completely, it can retract cranially and anastomosis becomes more difficult." — Yama (clinical) [Ep 2 · 3:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=180)
- "Leaving one quarter of the fistula uncut provides fixation of the distal esophagus and makes it easier to grasp the mucosa during anastomosis." — Yama (clinical) [Ep 2 · 3:20](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=200)
- "spk_0 does not cut all of the tip of the proximal esophagus; he leaves one-quarter to one-fifth of the cap of the proximal esophagus to grab with forceps, avoiding grasping the anastomotic site." — Yama (clinical) [Ep 2 · 3:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=230)
- "If there is a 1-3 vertebral body gap, the assistant can pull the proximal esophagus caudally using the uncut cap." — Yama (clinical) [Ep 2 · 4:20](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=260)
- "spk_0 places the first anastomotic stitch in the middle of the posterior wall, not at the edge, finding this easier especially with his technique." — Yama (clinical) [Ep 2 · 4:47](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=287)
- "spk_0 uses 6-0 or 5-0 PDS suture for the anastomosis." — Yama (clinical) [Ep 2 · 7:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=450)
- "The mucosa of both proximal and distal esophagus must be included in the anastomotic stitches; otherwise the patient will have postoperative stenosis." — Yama (clinical) [Ep 2 · 7:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=460)
- "spk_0 divides the tracheoesophageal fistula completely after placing one or two anastomotic stitches." — Yama (clinical) [Ep 2 · 8:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=520)
- "spk_0 divides the uncut cap of the proximal esophagus after placing 2-3 anastomotic stitches." — Yama (clinical) [Ep 2 · 9:00](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=540)
- "spk_0 does not touch the site of the anastomosis in the proximal and distal esophagus during his technique." — Yama (clinical) [Ep 2 · 9:20](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=560)
- "spk_1 tried spk_0's technique after seeing the video in September and found it worked well, though he was uncertain how much he needed the traction provided by the uncut tissue." (opinion) [Ep 2 · 9:45](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=585)
- "spk_1 suggests there is no downside to leaving the last bit of fistula uncut initially; if the stitch sets up perfectly, it can be taken, and if not, it can be cut and the anastomosis completed." (opinion) [Ep 2 · 10:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=640)
- "David Vanderzee (spk_2) thinks leaving the fistula partially connected to the trachea initially might be helpful, but his group does not do it." — David Vanderzee (opinion) [Ep 2 · 11:13](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=673)
- "David Vanderzee's group uses a transfixing suture to close the fistula to ensure it does not come off, and never uses clips because they tend to hook behind the anastomotic suture." — David Vanderzee (clinical) [Ep 2 · 11:30](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=690)
- "For type C esophageal atresia with considerable length, David Vanderzee's group puts in two sutures, makes them into sliding knots, and slowly brings the esophageal ends together, dividing tension between the two ends." — David Vanderzee (clinical) [Ep 2 · 11:55](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=715)
- "David Vanderzee's group finalizes the posterior anastomosis before putting through a tube and closing the anterior wall." — David Vanderzee (clinical) [Ep 2 · 12:25](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=745)
- "Mark Wolkan presented a technique from Atlanta in which a stitch is placed through the chest wall, through the proximal esophageal end, through the distal end, and back out through the chest wall, and held up during anastomosis." (host_summary) [Ep 2 · 13:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=830)
- "Jeff Blair (spk_3) speculates that in the next decade, mechanical devices may be used to grab and seal the lower esophageal pouch via the upper pouch, possibly with thoracoscopic or imaging facilitation." — Jeff Blair (opinion) [Ep 2 · 15:06](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=906)
- "Suet (spk_4) found it much easier to identify the fistula laparoscopically (likely meant thoracoscopically) and to appreciate how much esophagus to leave on the tracheal side." — Suet (opinion) [Ep 2 · 15:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=940)
- "Suet found dissecting the upper segment of the esophagus difficult, particularly in handling the esophagus without damaging the wall needed for anastomosis." — Suet (opinion) [Ep 2 · 16:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=970)
- "Sharif (spk_5), who started doing thoracoscopic TEF a year ago and has done three cases, finds the dissection and fistula division phase easy but the anastomotic phase difficult." — Sharif (opinion) [Ep 2 · 16:34](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=994)
- "Steve Rothenberg uses clips routinely for TEF repair." — Sharif (host_summary) [Ep 2 · 17:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1030)
- "There have been several instances where clips seem to erode or be implicated in TEF recurrences." — Sharif (host_summary) [Ep 2 · 17:25](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1045)
- "spk_1 has had a clip erode into the esophagus in his experience." (clinical) [Ep 2 · 17:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1060)
- "Steve Rothenberg, who has the largest experience with thoracoscopic TEF, has never had a clip erode." (host_summary) [Ep 2 · 17:55](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1075)
- "spk_1 uses metal clips for fistula closure." (clinical) [Ep 2 · 18:10](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1090)
- "spk_1 has tried Weck Hema-lock clips 2-3 times but finds the clip applier too large, reducing visualization compared to the metal clip applier." (opinion) [Ep 2 · 18:20](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1100)
- "Weck Hema-lock clips are not easy to remove if their position is unsatisfactory." (clinical) [Ep 2 · 18:40](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1120)
- "spk_0 believes that if the fistula is clipped very tightly, it will erode the muscle of the esophagus, but if the clip is applied just to oppose (not crush), it does not cause erosion." — Yama (opinion) [Ep 2 · 18:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1130)
- "Tight clipping may crush the esophageal muscle, erode it, and cause recurrence of the fistula." — Yama (opinion) [Ep 2 · 18:50](https://qa.library.globalcastmd.com/watch/thoracoscopic-repair-of-tracheo-esophageal-fistula-tricks-pediatric-surgery-424?t=1130)

## Changelog
- Sep 15: 4 items added automatically
- Sep 13: 1 item added automatically
- Sep 12: 2 items added automatically
- Sep 8: 1 item no longer name tracheoesophageal fistula
- Sep 7: 7 items added automatically

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