Esophageal Atresia & Tracheoesophageal Fistula

Esophageal Atresia & Tracheoesophageal Fistula
Originally uploaded by Critical Mess.

Now that Frankie's surgery is over and his mom and I have had a chance to let out a huge sigh of relief, I'm in good enough shape to fill y'all in on the details of the procedure. The diagram to the right illustrates several variations on the theme of Frankie's condition, his particular case most closely resembling example D, an esophageal atresia with a tracheoesophageal fistula. Simply put, his esophagus did not fully develop during gestation. The upper portion of the esophagus formed a small sack, or atresia, which prevented it from growing into the distal portion of the esophagus (attached to the stomach). In turn, the distal esophagus attached to the trachea instead, and a small opening (fistula) created a passageway between the stomach and the lungs. Had Frankie not been a preemie, this condition might not have been discovered until after he began to breastfeed, which would have created the rather more serious complication of pneumonia (fluid would travel down the trachea instead of the esophagus, and therefore into both the stomach and the lungs). In a way, it was fortunate that he came early, as the atresia was discovered when they tried to insert a feeding tube into his throat (something they general don't do for full-term babies). The procedure to correct the atresia and fistula involves two primary steps: first, the distal esophagus is detached from the trachea, and the fistula is sealed with sutures; second, the atresia is opened with an incision, then attached to the opening at the top of the distal esophagus and sealed with a circular suture. All of this is done through a small incision on the left side of Frankie's chest. The surgery did not require his ribs to be broken or his chest cavity to be opened, and he lost only about 1cc of blood. The doctor also inserted a Broviac catheter into Frankie's chest, which will minimize the number of times they have to fish for a vein when inserting antibiotics and other medications, and which will later be used for introducing fluids and nutrients. Really, it's amazing what they did, and as of this morning, Frankie is doing great, and there are no signs of any complications. If the sutures hold, he'll be ready to begin ingesting food by the end of next week.