Pediatric Surgery esophageal atresia

Esophageal Atresia

Definition

In cases of developmental defect of the esophagus, the upper pouch is large and blind. The lower pouch is thin and communicates with the bronchus, in most cases.

Objectives

•   To disconnect the fistula from the bronchus

•   To anastomose the upper with the lower pouch.

Position

Lateral, with the left chest along the table.

Anesthesia

General with endotracheal intubation.

Procedure

   1.  Right posterolateral thoracotomy—5 cm long.

   2.  Divide subcutaneous tissue and intercostal muscles.

   3.  Mobilize parietal pleura upto mediastinum.

   4.  Retract the ribs with Finochietto retractor.

   5.  Divide the azygos vein between ligatures.

   6.  Identify the lower pouch and divide it from the bronchus.

   7.  Suture the fistulous opening in the bronchus.

   8.  Mobilize the upper pouch upto the neck.

   9.  Anastomose the upper and the lower pouches—tension free.

10.  Drain the extrapleural space by an under water seal bottle.

11.  Approximate the ribs with the pericostal sutures.

12.  Close the wound in layers.

Instrument

•   General pediatric set

•   Special:

     a.  Finochietto chest retractor

     b.  Malleable retractors

     c.  Right angled artery forceps

     d.  Long thumb forceps

     e.  Long needle holder

     f.   Red rubber catheter #6

     g.  Feeding tube # 6.

Sutures

•   4/0 Catgut 

•   4/0, 5/0       Silk

•   5/0              Prolene

•   5/0              Nylon.

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