Esophageal atresia and tracheoesophageal fistula are congenital anomalies of the esophagus (food pipe) and trachea (windpipe). These two conditions often occur together and are usually diagnosed at birth or shortly thereafter. In most cases, diagnosis is made during pregnancy. Important diagnostic criteria include an enlarged upper esophagus or the inability to visualize the stomach. In approximately 85% of all esophageal atresia cases, the upper part of the esophagus is completely closed, and the lower part connects to the trachea. Surgical intervention should be performed immediately after birth. If diagnosed during pregnancy, a multidisciplinary approach should be applied before delivery. The patient should be referred to a center where obstetrics-perinatology, neonatal intensive care, and pediatric surgery units work together. If the diagnosis is made after birth, the newborn should be transferred to a center with an experienced surgical team and neonatal intensive care unit.

Although esophageal atresia is rare, its incidence is about 1 in 2,500 to 4,500 births. Esophageal atresia and tracheoesophageal fistula often coexist, but in about 5% of cases, esophageal atresia occurs without a tracheoesophageal fistula.

Symptoms

If not diagnosed during pregnancy, diagnosis is made shortly after birth. The newborn exhibits serious symptoms such as respiratory distress, immediate vomiting, severe coughing, and sudden cessation of breathing while breastfeeding or bottle-feeding. Definitive diagnosis is confirmed when a nasogastric tube inserted through the baby’s nose fails to pass into the stomach and coils at the upper obstructed part of the esophagus. In infants diagnosed with esophageal atresia, urinary system (urinary tract) and cardiac diseases should also be screened because they have a higher risk of these conditions compared to infants without esophageal atresia.

Treatment

If the baby’s general condition is stable, surgery should be performed as soon as possible. The abnormal connection between the esophagus and trachea must be removed. The obstructed upper end of the esophagus is opened and sutured to the lower end to restore the continuity of the digestive system. After surgery, the baby is usually monitored in the neonatal intensive care unit for about a week, followed by pediatric surgical follow-up.

In the past, esophageal atresia surgery was performed through thoracotomy, which involves fully opening the chest. However, for the last 25 years, thoracoscopic (minimally invasive) surgery has been the preferred method worldwide. In Turkey, only a few centers perform this minimally invasive esophageal atresia surgery. Compared to open surgery, this technique offers many advantages. The procedure is performed through three small 3-millimeter incisions, resulting in fewer wound infections. There are no skeletal or muscle abnormalities, and the baby undergoes much less trauma. This accelerates the healing process, and respiratory and feeding functions return to normal much sooner. Regardless, the baby must be monitored under intensive care conditions after surgery. Therefore, the surgery must be performed in a center where a multidisciplinary approach is available.

It is also important to remember that these babies require systematic follow-up regarding feeding, growth, and development as they grow older.

Postoperative Care

After surgery, leakage between sutures can occur in 25-30% of cases worldwide. However, this leakage generally closes within a week without requiring further surgical intervention. In the late period, esophageal strictures may develop. If this occurs, patients should undergo endoscopic esophageal dilation. Nearly all patients with esophageal strictures can return to a normal feeding routine after no more than two dilations.

After surgery, babies are usually monitored in the neonatal intensive care unit. Intravenous fluids and antibiotics are given until nutrition and fluid balance are stabilized. A special feeding plan is also applied. The recovery process depends on the presence of other illnesses.

During or after surgery for esophageal atresia and tracheoesophageal fistula, complications such as leakage, strictures, infection, bleeding, feeding, and respiratory problems may occur, though these are rare. Most can be treated with medication without the need for further surgery.

Early diagnosis and appropriate surgical treatment of esophageal atresia ensure healthy growth and development of the child. Careful postoperative monitoring and care reduce the risk of complications and support the healing process.

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