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17. Treatment of esophageal-tracheal fistulas
Elimination of congenital esophageal-tracheal fistula only possible through surgery. Surgical intervention is carried out after the diagnosis is established.
Preoperative. The child is completely excluded from oral feeding - all the required amount of liquid is introduced into the stomach through a tube, which is removed after each feeding. From the first day, active anti-pneumonic treatment begins: antibiotics, oxygen therapy, UHF currents on the chest, alkaline aerosol.
The operation for congenital esophageal-tracheal fistula is performed under endotracheal anesthesia and with blood transfusion. The position of the child is on the left side.
Operation technique. The most convenient access for infants is extrapleural. Along the fourth intercostal space on the right.
The lung covered with pleura is retracted forward and inward, the mediastinal pleura is exfoliated above the esophagus. The esophagus is mobilized for 1,5-2 cm up and down from the place of its communication with the trachea.
In the presence of a long fistulous passage, the latter is isolated, tied with two silk ligatures, crossed between them, and the stumps are treated with an iodine solution.
With a wide and short fistula, the esophagus is carefully cut off with scissors from the trachea, and the holes formed are closed with a double-row continuous suture with atraumatic needles. To prevent postoperative narrowing of the esophagus, the latter is sutured in the transverse direction (over the catheter inserted before the operation).
The most difficult to eliminate is a large esophageal-tracheal fistula, in which both organs have common walls for some length (0,7-1 cm).
In such cases, the esophagus is transected above and below the junction with the trachea. The holes formed on the trachea are sutured with two rows of sutures, then the continuity of the esophagus is restored by creating an end-to-end anastomosis.
Postoperative treatment. In the postoperative period, the child continues to receive active antipneumonic therapy, since surgery usually causes an exacerbation of the process in the lungs.
An elevated position is created for the patient, an aerosol is prescribed, humidified oxygen is constantly given, antibiotics, cardiac agents are administered.
On the first day, the child needs parenteral nutrition, then feeding is carried out in fractional doses every 3 hours through a thin tube left during the operation. The amount of fluid is calculated depending on the age and body weight of the child. Within 2-3 days, 1/3 of the volume of liquid is injected through a probe, the rest is intravenous drip. The probe is removed on the 5th-6th day (when creating an end-to-end anastomosis, feeding through the probe is continued for 9-10 days). By the 6-8th day, the child should receive the usual age norm of breast milk. Older children are prescribed liquid food from the 7-8th day after the operation.
Authors: Drozdov A.A., Drozdova M.V.
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