This procedure is done while the child is under general anesthesia (asleep and pain-free). The surgeon makes a cut in the right chest between the ribs. The tracheoesophageal fistula is closed off, then the upper and lower portions of the esophagus are sewn together.

TEF and esophageal atresia are life-threatening problems that often require immediate medical attention and treatment. Untreated, saliva and fluids from the gastrointestinal track may be breathed into the lungs (aspirated), which can cause choking. Normal swallowing and digestion of food cannot occur with the abnormal esophagus.

However, some infants, such as those who have a low birth weight or other birth defects that cause severe illness, may not be able to have immediate surgery. Surgery will be done after the other problems have been treated or have gone away. In these cases, a gastrostomy tube is placed in the stomach to relieve pressure and prevent fluid from moving up the esophagus and into the trachea.

In most healthy infants, certain types of TEF are easier to repair after the baby is a few months old (about 2 to 4 months). While waiting, the esophagus may need to be occasionally stretched and widened. This makes the future repair easier.

Risks for any anesthesia include:

• Reactions to medications
• Problems breathing

Risks for any surgery include:

• Bleeding
• Infection

Additional risks include:

• Narrowing of repaired organs
• Collapsed lung (pneumothorax )
• Hypothermia

Tracheoesophageal fistula and esophageal atresia can usually be corrected surgically. If the two parts of the esophagus are too short, further surgery may be needed and a gastrostomy tube may be temporarily used for feedings.

After surgery, the infant will be cared for in a hospital's neonatal intensive care unit (NICU). The infant will be placed in a machine called an isolette (incubator) to provide warmth and prevent infection.

Additional treatments after surgery may include:

• Antibiotics
• Breathing assistance (mechanical ventilation)
• Fluids through a vein
• Oxygen
• Pain medicines

A tube placed through the nose into the stomach will keep the stomach empty. Feedings are started through this tube as soon as bowel function starts again. Feedings are started very slowly, and often infants are slow to feed. The baby may need feeding therapy and lots of encouragement. How long a baby stays in the hospital depends on seriousness of the surgery and the baby's condition.

Orenstein S, Peters J, Khan S, Youssef N, Hussain SZ. Congenital anomalies: esophageal atresia and tracheoesophageal fistula. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 316.