Tracheoesophageal fistula repair by transcervical approach

The possibility of esophageal atresia and esophageal tracheal fistula survival after birth is related to the infant's weight and maturity, and must be determined by the severity of the malformation and the complications of the respiratory tract. Surgical treatment should be performed after the diagnosis is confirmed in order to prevent milk and saliva from entering the respiratory tract. But be prepared for surgery to improve the lungs and general condition and create good conditions for surgery. The trend in recent years is that, regardless of the type of infant, it is necessary to strive for an anastomosis on the premise of preoperative preparation. Treatment of diseases: tracheoesophageal fistula Indication Tracheal esophageal hernia repair through the neck is suitable for the position of the esophageal tracheal fistula, and the fistula is located in the cervical esophagus. Contraindications Severe aspiration pneumonia must be controlled before surgery. Preoperative preparation 1. Correct aspiration pneumonia. 2. Correct dehydration, anemia, etc., to improve the general condition. 3. In order to facilitate the positioning of the fistula during operation, a thin catheter is inserted through the endoscope from the fistula of the trachea to the esophagus side. Surgical procedure Incision A transverse incision was made from the sternal fossa to the right lateral neck parallel to the 1 cm above the collarbone. 2. Determine the fistula Cut off the sternal attachment of the sternocleidomastoid muscle. The carotid sheath is found and pulled outward, and the cervical esophagus is released parallel to the posterior wall of the trachea, and is lifted with gauze to find the fistula. 3. Cut the suture tube Cut off the fistula. The tracheal side fistula was sutured with a layer of intermittent suture to prevent stenosis of the airway, and the esophageal mucosa and the muscular layer were intermittently sutured. The nasogastric tube was inserted for postoperative tube feeding. 4. Stitching The cut sternocleidomastoid muscle is sutured, and the skin is cut under the neck incision or the cigarette is drained. complication Cervical esophageal fistula Often occurs 3 to 7 days after surgery. When the neck is red and swollen, part of the incision can be separated. Bubbles and saliva can be seen to flow out, and the dressing is opened. Generally, it can be cured in 10 to 14 days. 2. hoarse voice During the operation of the cervical esophagus, one side of the recurrent laryngeal nerve was injured. With local physiotherapy, it can be recovered within 2 weeks.