Treatment

The overall aim of surgical correction is early division of any fistula with the respiratory tract to protect the lungs and airway, and restoration and maintenance of esophageal continuity to allow normal feeding. Following diagnosis, a Replogle tube is placed in the upper esophageal pouch, allowing suction of secretions and minimizing of the risk of pulmonary aspiration. Surgical repair involves ligation and division of any fistula, and primary anastomosis of the two ends of the esophagus where possible. Infants in whom the gap between the two ends of the esophagus is too wide for primary anastomosis to be achieved pose a problem. These infants are initially fed by gastros-tomy and the esophageal anastomosis is re-attempted after 6 weeks. If recurrent attempts at this remain unsuccessful, esophageal replacement alternatives including colonic interposition and gastric transposition are considered.

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