Collection
Esophageal Atresia and Tracheoesophageal Fistula
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
When there is an anastomosis under tension and concern about a leak, it is advisable to get some tissue between the two suture lines to prevent development of a recurrent fistula. Tips and Tricks: EA & TEF · 3:19
Thoracoscopic Esophageal Atresia Repair Tips & Tricks: Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course,Dr. Steven Rothenberg shares tips and tricks for thoracoscopic esophageal atresia repair. Discussion involves intraoperative ventilation, operating room layout, patient positioning, trocar p
video · Sep 2018
Rothenberg Thoracoscopic Technique Video: EA/TEF
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Dr. Steven Rothenberg reviews the basics of esophageal atresia, the current treatment modalities, the possible complications (and how they can be avoided), and tips and tricks for managing variations.
video · Jan 2019
Tips and Tricks: EA & TEF
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Dr. Steven Rothenberg leads a discussion on tips and tricks that are useful in operative and post-operative management of esophageal atresia and tracheoesophageal fistula.
video9:27 · Jan 2019
QUAD #10 Pt.1: History of Thoracoscopic Repair of Esophageal Atresia (EA) & Tracheoesophageal Fistula (TEF) with Dr. Steve Rothenberg
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In this video we explore the transformative benefits of thoracoscopic repair for esophageal atresia with Dr. Steve Rothenberg from Rocky Mountain Hospital for Children. This video covers:
Advocating for Minimally Invasive Surgery: The
video6:27 · Jun 2024
QUAD #10 Pt.2: Surgical Technique for Thoracoscopic Repair of Tracheoesophageal Fistula (TEF) with Dr. Steve Rothenberg
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In this video we’ll talk about minimally invasive thoracoscopic tracheoesophageal fistula (TEF) repair with Dr. Steve Rothenberg from Rocky Mountain Hospital for Children. This video covers:
Anesthesia: Using CO2 to collapse the lu
video · Jun 2024
QUAD #10 Pt.3: Advantages of Thoracoscopic Repair of Esophageal Atresia with Dr. Steve Rothenberg
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In this video we’ll talk about benefits of thoracoscopic tracheoesophageal fistula (TEF) repair in reducing tracheomalacia and improving patient outcomes with Dr. Steve Rothenberg from Rocky Mountain Hospital for Children. Here are some hig
video · Jun 2024
Long Gap Esophageal Atresia – How I Do It: Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course, Drs Daniel von Allmen, David van der Zee, Russell Jennings, Steve Rothenberg, Mac Harmon, Whit Holcomb, Todd Ponsky and Rachel Hankediscuss long gap esophageal atresia. Discussion involvese
video · Sep 2018
Long Gap Technique Videos: EA & TEF
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Dr. Arnold Coran discusses his management of long-gap esophageal atresia, and presents a video detailing his technique for measurement of the gap utilizing a neonatal endoscope.Dr. Steven Rothenberg shows a technique video detailing his ope
video · Jan 2019
Update Course 2021: MAGNET THERAPY FOR ESOPHAGEAL ATRESIA
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At Pediactric Surgery Update Course 2021, Dr. Bethany Slater, MD from University of Chicago ComerChildren's Hospital and Dr. Steven Rothenberg, MD from Rocky Mountain Hospital for Children sharing their cases on using magnet therapy as an a
video · May 2022
Placing a catheter across the H-type fistula can occasionally be helpful for identification, though it was not used in this case. VATS H-Type Fistula Repair - Technique · 3:00
VATS H-Type Fistula Repair - Technique
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Dr. Steven Rothenberg describes his technique for thoracoscopic repair of an H-type tracheoesophageal fistula. Key steps to the procedure include opening of the apical pleura with a vessel sealer, identification of the esophagus and the tr
video4:36 · Nov 2018
IPEG 2018 - RIGHT THORACOSCOPIC REPAIR OF AN H-TYPE TRACHEOESOPHAGEAL FISTULA
video3:52 · Apr 2021Private
Featured picks for families are being prepared — the summaries above are written for you.
H-type tracheoesophageal fistula repair can be performed thoracoscopically using a three-port technique with the patient in modified lateral decubitus position rolled 45 degrees prone [e749-c4, e749-c5]. The approach begins at the apex with pleural opening and dissection using a 3 mm vessel sealer . A critical technical step is developing a plane between esophagus and trachea below the fistula level before encountering the adherent area . Dissection proceeds above the fistula to create a retro-fistula plane, allowing passage of an instrument behind the fistula with care to avoid injury to the esophagus or membranous trachea [e749-c11, e749-c12]. While traditional technique involved division followed by oversewing both ends , a 5 mm endoscopic stapler can be used in larger infants to divide the fistula with two rows of staples on each side [e749-c15, e749-c18]. Apical fat is mobilized and sewn over the esophageal staple line to separate the two ends and reduce recurrent fistulization risk . The pleura is closed over the repair to contain potential leaks . This approach has been successfully applied even after failed endoluminal ablation attempts .
- Thoracoscopic H-type fistula repair uses three ports with the patient in 45-degree prone-rolled lateral position, beginning dissection at the apex. [e749-c4, e749-c5, e749-c7]
- Developing a plane between esophagus and trachea below the fistula before encountering adherent tissue is a key safety maneuver. [e749-c8]
- A 5 mm endoscopic stapler can divide the fistula with two staple rows per side in sufficiently large infants, replacing traditional divide-and-oversew technique. [e749-c15, e749-c18]
- Interposing apical fat between esophageal and tracheal staple lines helps prevent recurrent fistulization after division. [e749-c19]
- Closing pleura over the repair contains potential leaks; thoracoscopic approach can succeed even after failed endoluminal ablation. [e749-c3, e749-c20]
For patients & families
When a baby is born with an H-type tracheoesophageal fistula, there is an abnormal connection between the breathing tube (trachea) and the swallowing tube (esophagus), which can cause food or liquid to enter the lungs and lead to repeated lung infections. Doctors sometimes try to close this connection using a scope passed through the mouth, but when those attempts don't work, surgery through the chest may be needed. During the thoracoscopic repair discussed by the surgeons, small instruments and a camera are placed through tiny incisions in the chest wall, and the surgeon carefully separates the two tubes and divides the abnormal connection. The team described using a small stapling device to cut and seal both ends of the fistula at the same time, then covering the area with nearby tissue to help prevent the connection from reforming. After surgery, the lung is re-expanded and the child is monitored closely, with follow-up checks at 2 weeks and 3 months to make sure the repair is holding.
When a baby is born with an H-type tracheoesophageal fistula, there is an abnormal connection between the breathing tube (trachea) and the swallowing tube (esophagus), which can cause food or liquid to enter the lungs and lead to repeated lung infections. Doctors sometimes try to close this connection using a scope passed through the mouth, but when those attempts don't work, surgery through the chest may be needed. During the thoracoscopic repair discussed by the surgeons, small instruments and a camera are placed through tiny incisions in the chest wall, and the surgeon carefully separates the two tubes and divides the abnormal connection. The team described using a small stapling device to cut and seal both ends of the fistula at the same time, then covering the area with nearby tissue to help prevent the connection from reforming. After surgery, the lung is re-expanded and the child is monitored closely, with follow-up checks at 2 weeks and 3 months to make sure the repair is holding.
Expert statements from the recordings in this collection.
VATS H-Type Fistula Repair - Technique
The patient was a 3-month-old infant with multiple medical issues who had recurrent aspiration.
Upper GI study showed an H-type tracheoesophageal fistula.
There were 2 prior attempts at endoluminal ablation before this thoracoscopic repair.
For thoracoscopic H-type fistula repair, the patient is placed in modified lateral decubitus position rolled prone approximately 45 degrees.
Three ports were used: one 4 mm port (later advanced to 5 mm) and two 3 mm ports.
A 4 mm 30-degree lens was used for the procedure and placed behind the tip of the scapula.
The procedure starts in the apex using a 3 mm vessel sealer for dissection and to open the pleura.
Developing a plane between esophagus and trachea below the level of the fistula is an important maneuver to help safely separate the two structures before encountering the very adherent area.
Placing a catheter across the H-type fistula can occasionally be helpful for identification, though it was not used in this case.
Expert opinion3:00
A 3 mm hook cautery was used to pull on fibers and separate them away from critical structures.
Dissection is carried out above the fistula so that a retro-fistula plane can be developed.
An instrument is passed around behind the fistula, taking care not to injure the esophagus or membranous portion of the trachea.
A 2-0 silk suture is passed around the fistula to help with retraction.
Previously, the technique involved dividing the fistula and then oversewing the two ends.
In this case, with the child large enough and availability of a 5 mm stapler, a decision was made to use the stapler to divide the fistula.
Care must be taken to ensure the recurrent laryngeal nerve and other important structures are not within the field of dissection.
The lower port in the posterior axillary line was enlarged to 5 mm to accommodate the stapler.
A single application of the 5 mm stapler divided the fistula, placing two rows of staples on either side.
Apical fat is taken and sewn down to cover the esophageal end of the staple line to help separate the two staple lines and prevent recurrent fistulization.
The pleura is closed over the divided fistula so that any leak would remain contained.
The lung was re-expanded and no chest tube was left.
The patient was examined at 2 weeks postoperatively and the fistula was assessed at 3 months.
Tips and Tricks: EA & TEF
Spitz uses a 6 French feeding tube (not a Replogle) for feeding in the first few days after esophageal atresia repair.
Spitz0:04
Jack leaves a 5 French feeding tube, both for feeding and to protect the back wall during the anastomosis.
Jack0:18
Steve uses a 10 French Replogle across the anastomosis.
When separating the upper pouch from the membranous trachea, Steve uses blunt and sharp dissection; he only uses cautery if he can clearly see the tissues and knows he is not injuring the membranous trachea.
Steve1:10
Surgeons have created holes in the membranous trachea during dissection of the plane between the membranous trachea and the medial wall of the upper pouch, resulting in acquired tracheoesophageal fistula that is very difficult to fix.
Cautery should never be used to dissect the upper pouch off the membranous trachea; sharp dissection is the only safe way.
For extracorporeal knots on the first couple of stitches, Vicryl should not be used because it is very hard to tie an extracorporeal knot with it.
Steve2:19
If tying extracorporeally, PDS should be used because it slides better than Vicryl.
Steve2:41