Surgical Management:

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.,