Surgical management consists of primary repair which involves end to end anastomosis with excision of the fistula and delayed and staged surgery. When the baby is not clinically fit for surgery because of pneumonitis or low birth weight, a gastrostomy is performed.
Stages of Surgery
1) Left Cervical esophagostomy and gastrostomy
2) Thoracotomy and ligation of fistula
3) Replacement of the gap between two pouches at six to eights months of age by gastric tube
Preoperative management consists of nursing the child in upright position, no feeding, frequent low pressure suctioning, maintenance of fluid and electrolyte balance by intravenous fluids and giving antibiotics prophylactically. Postoperative nursing management consists of monitoring the intravenous fluids, gastrostomy feeding as advised and subsequent oral feeding depending on general condition of child, and watch and preventing complications. That occur after EA with TEF.,