# Tracheoesophageal Fistula — GCMD Library living collection

Everything in the library about tracheoesophageal fistula — built automatically from dossiers that name it.

Updated: n/a · 6 episodes · 102 cited statements

## Episodes
### Surgical Management
- [Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791) — podcast · 10:56 · [machine version](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791.md)
- [QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114) — video · 7:37 · [machine version](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114.md)

### Evidence & Research
- [Case Based Journal Review: Esophageal Atresia in 2022](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631) — podcast · 17:55 · [machine version](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631.md)
- [Quick Literature Updates Episode 9](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770) — video · [machine version](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770.md)

### Case-Based Learning
- [Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739) — video · 120:59 · [machine version](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739.md)

### Long-Term Care
- [QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201) — video · 10:19 · [machine version](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=0) Introduction and Aspiration Framework (Ep 1)
- [10:40](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=640) Case 1: Second H-Type TEF After Primary Repair (Ep 1)
- [22:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1320) Dual-Scope Technique and Endoscopic TEF Repair (Ep 1)
- [35:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2100) Positive-Pressure Air Test and Repeat Endoscopic Repair (Ep 1)
- [50:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3000) Complex Case: Type D TEF and Slide Tracheoplasty (Ep 1)
- [60:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3600) Button Battery Injuries and Slide Tracheoplasty Failures (Ep 1)
- [70:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4200) Transtracheal Repair and High H-Type Fistulas (Ep 1)
- [85:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5100) Missed Laryngeal Cleft in Long-Standing Aspiration (Ep 1)
- [95:00](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5700) Bronchoesophageal Fistula: Multi-Fistula Case and Lobectomy (Ep 1)
- [106:40](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6400) Hearing Aid Mold Foreign Body and Stent Management (Ep 1)
- [116:40](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=7000) Tracheal Pouch Marsupialization and Closing Remarks (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=0) Introduction and Gap Measurement Protocol (Ep 2)
- [1:08](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=68) Esophageal Elongation Techniques (Ep 2)
- [3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195) Foker Technique Outcomes and Morbidity (Ep 2)
- [4:36](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276) Esophageal Replacement Options and Colonic Interposition Technique (Ep 2)
- [8:00](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=480) Complications and Advantages of Colonic Interposition (Ep 2)
- [9:56](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=596) Growth vs Stretch Mechanism Discussion (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=0) Introduction and case setup: Type C esophageal atresia repair (Ep 3)
- [2:27](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=147) Azygous vein preservation: systematic review evidence (Ep 3)
- [5:32](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=332) Transanastomotic feeding tubes: Quebec multicenter study (Ep 3)
- [10:29](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=629) Routine chest drain insertion: meta-analysis findings (Ep 3)
- [13:25](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=805) Postoperative antibiotics and acid suppression: Midwest Consortium data (Ep 3)
- [16:53](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=1013) Summary and closing remarks (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=0) Introduction and First Paper Setup (Ep 4)
- [1:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=70) Transanastomotic Tubes and Patent Processus Vaginalis Studies (Ep 4)
- [2:13](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=133) Biliary Atresia Transplant Timing (Ep 4)
- [4:14](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=254) Social Risk Screening and Closing (Ep 4)
- [0:00](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=0) Introduction and Conference Context (Ep 5)
- [0:57](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=57) Case 1: Complete Tracheal Rings with TEF (Ep 5)
- [1:46](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=106) Case 2: Type 3 Cleft with Residual TEF (Ep 5)
- [3:33](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=213) Case 3: Recurrent Type C TEF with Mediastinal Communication (Ep 5)
- [6:33](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=393) Summary and Key Takeaways (Ep 5)
- [0:00](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=0) Introduction to the Aerodigestive and Esophageal Center at Cincinnati Children's (Ep 6)
- [1:28](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=88) Speech Pathology Role and Team Structure (Ep 6)
- [3:39](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=219) ENT Perspective on Aerodigestive Care (Ep 6)
- [4:06](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=246) Gastroenterology Perspective: GERD, EOE, and Anatomic Issues (Ep 6)
- [6:25](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=385) Pulmonology Perspective: Insufficiency, Aspiration, and Airway Obstruction (Ep 6)
- [9:34](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=574) General Surgery Role and Summary (Ep 6)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Patients with a transanastomotic tube had a 2.72 times higher risk of developing a stricture post-operatively after esophageal atresia with tracheoesophageal fistula repair" (clinical) [Ep 4 · 1:10](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=70)
- "The Midwest Pediatric Surgery Consortium study examined every patient who had a laparoscopic pyloric myotomy to identify patent processus vaginalis and followed them annually" (clinical) [Ep 4 · 1:30](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=90)
- "Of 526 patients enrolled in the PPV study, 283 had a patent processus vaginalis (bilateral, right, or left)" (epidemiological) [Ep 4 · 2:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=120)
- "Of 208 patients with at least one year follow-up, only three underwent inguinal hernia repair, all within the first year" (clinical) [Ep 4 · 2:13](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=133)
- "Most patent processus vaginalis do not turn into inguinal hernias based on four-year interim analysis data" (clinical) [Ep 4 · 2:35](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=155)
- "Liver transplantation for biliary atresia can be performed as initial treatment (primary) or after failed Kasai hepatoportoenterostomy (salvage)" (clinical) [Ep 4 · 2:45](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=165)
- "The current standard in the US for biliary atresia is Kasai first and liver transplant only if that fails" (guideline) [Ep 4 · 3:05](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=185)
- "Children who had an early salvage liver transplant (before age one) and children who had a primary liver transplant had similar outcomes" (clinical) [Ep 4 · 3:30](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=210)
- "Children who had a late salvage liver transplant had improved graft survival compared to other groups" (clinical) [Ep 4 · 3:45](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=225)
- "Some children who undergo the Kasai procedure will never end up needing a liver transplant" (clinical) [Ep 4 · 4:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=240)
- "Social risk screening in pediatrics involves screening for risk factors including food and housing insecurity, financial strain, and unsafe environments" (clinical) [Ep 4 · 4:30](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=270)
- "There is low concordance between screening results showing who might need resources and who is actually asking for more resources" (epidemiological) [Ep 4 · 5:00](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=300)
- "Families may feel uncomfortable with social risk screening and may think there might be downstream repercussions based on their answers" (opinion) [Ep 4 · 5:15](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=315)
- "There may be racial biases in screening practices, with non-white patients potentially being asked social risk questions more often" (epidemiological) [Ep 4 · 5:28](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=328)
- "Current social risk screening protocols may not be effective and may actually lead to more inequities" (opinion) [Ep 4 · 4:50](https://library.globalcastmd.com/watch/quick-literature-updates-episode-9-6770?t=290)
- "Slide tracheoplasty can be used as a method of repairing challenging tracheoesophageal fistulas" — Michael Rutter (clinical) [Ep 5 · 0:49](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=49)
- "In a case with complete tracheal rings and TEF, both conditions were repaired simultaneously because there was no other option" — Michael Rutter (clinical) [Ep 5 · 1:11](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=71)
- "The slide tracheoplasty technique involves transecting the trachea above and below the hole with a bevel to avoid losing too much trachea" — Michael Rutter (clinical) [Ep 5 · 1:25](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=85)
- "Part of the trachea is used to repair the esophagus, then the trachea is slid over the top of it, often with a periosteal interposition graft" — Michael Rutter (clinical) [Ep 5 · 1:35](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=95)
- "Finding an H-type TEF can be quite difficult and is done via tracheoscopy or esophagoscopy" — Kim Pribben (host_summary) [Ep 5 · 2:06](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=126)
- "In the slide tracheoplasty repair, a flap of trachea is sewn onto the esophagus so the front wall of the esophagus becomes a piece of trachea, using a quick running suture technique with 4-0 PDS" — Michael Rutter (clinical) [Ep 5 · 2:18](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=138)
- "When the distance between trachea and esophagus is large, using nerve hooks and slowly tightening multiple throws brings the structures together" — Michael Rutter (clinical) [Ep 5 · 2:47](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=167)
- "Serial esophagoscopies provide a good picture of outcomes in challenging TEF repair cases" — Kim Pribben (host_summary) [Ep 5 · 2:59](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=179)
- "In the Swedish patient case, esophagoscopy at one month post-op showed the suture line where trachea was sewn to esophagus with the front wall being a piece of trachea" — Michael Rutter (clinical) [Ep 5 · 3:08](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=188)
- "The Swedish patient returned to eating and drinking everything despite having a very short trachea" — Michael Rutter (clinical) [Ep 5 · 3:24](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=204)
- "In the 4-year-old case, initial stabilization was achieved by placing an esophageal stent, which did not fix the holes but eliminated the mediastinal communication" — Michael Rutter (clinical) [Ep 5 · 4:23](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=263)
- "A slide tracheoplasty open approach provides much better visualization in the operating field for complex cases" — Kim Pribben (host_summary) [Ep 5 · 4:42](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=282)
- "A transsternal, transtracheal approach provides fantastic exposure to the esophagus" — Michael Rutter (clinical) [Ep 5 · 4:50](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=290)
- "Tibial periosteum serves as a good interposition graft" — Michael Rutter (clinical) [Ep 5 · 4:55](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=295)
- "Periosteum is effective at protecting one lumen from another" — Michael Rutter (clinical) [Ep 5 · 5:05](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=305)
- "A pulmonologist aids the surgeon by looking down the ET tube, which allows for additional visualization and identification of the fistula" — Kim Pribben (host_summary) [Ep 5 · 5:34](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=334)
- "The repair includes transection of the trachea and esophagus, performing a slide esophagoplasty, placing the interposition graft, and closing the trachea" — Kim Pribben (host_summary) [Ep 5 · 5:42](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=342)
- "In the 4-year-old case, the patient was extubated the next day with esophagram and bronchoscopy performed at one week" — Kim Pribben (host_summary) [Ep 5 · 6:03](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=363)
- "The 4-year-old patient was back to eating ice cream at 10 days post-op" — Kim Pribben (host_summary) [Ep 5 · 6:09](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=369)
- "Slide tracheoplasty is not appropriate for every TEF case, but it is useful to know the option is available" — Michael Rutter (opinion) [Ep 5 · 6:26](https://library.globalcastmd.com/watch/quad-6-slide-tracheoplasty-for-tef-otolaryngology-approach-with-dr-mike-rutter-8114?t=386)
- "Cincinnati Children's Hospital hosted the Quad Conference in October 2022, combining four conferences: International Organization for Esophageal Atresia, Aerodigestive Society Conference, Cincinnati Children's Airway Course, and Cincinnati Children's Pediatric Dysphagia Series." — Lizzie Lee (host_summary) [Ep 6 · 0:15](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=15)
- "Cincinnati Children's has one of the largest aerodigestive centers in the world." — Lizzie Lee (host_summary) [Ep 6 · 0:47](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=47)
- "The expert multidisciplinary team includes speech pathology, otolaryngology, gastroenterology, pulmonology, and pediatric general surgery." — Lizzie Lee (host_summary) [Ep 6 · 0:55](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=55)
- "The vision of the Aerodigestive and Esophageal Center is to improve efficiency and communication between team members and the family." — Claire Miller (clinical) [Ep 6 · 1:28](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=88)
- "The center provides coordinated multidisciplinary care to children with congenital or acquired complex digestive and airway disorders." — Lizzie Lee (host_summary) [Ep 6 · 1:37](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=97)
- "The clinical assessment is a poor predictor when there are airway protection issues." — Claire Miller (clinical) [Ep 6 · 2:44](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=164)
- "Video fluoroscopic swallowing study analyzes different phases of swallowing." — Lizzie Lee (host_summary) [Ep 6 · 2:52](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=172)
- "FEES (fiber optic endoscopic evaluation of swallowing study) allows visualization of pharyngeal and laryngeal structures and assessment of function, aspiration, and residual after each swallow." — Lizzie Lee (host_summary) [Ep 6 · 2:59](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=179)
- "High-resolution pharyngeal manometry allows objective assessment of the pressures of the swallow to understand what is underlying a swallowing dysfunction." — Claire Miller (clinical) [Ep 6 · 3:13](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=193)
- "ENT looks at swallowing study results and helps stratify the risk of proceeding with airway reconstruction and decannulation." — Lizzie Lee (host_summary) [Ep 6 · 3:48](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=228)
- "In aerodigestive patients, ENT performs esophageal and airway reconstruction, cleft repair, drool procedures, and manages vocal folds and mobility." — Lizzie Lee (host_summary) [Ep 6 · 3:54](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=234)
- "GERD pathophysiology includes an incompetent lower esophageal sphincter." — Lizzie Lee (host_summary) [Ep 6 · 4:19](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=259)
- "Patients with TEF have a lot of other things other than incompetent lower esophageal sphincters, including motility problems, hernias, and delayed emptying." — Scott Pentik (clinical) [Ep 6 · 4:31](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=271)
- "General signs and symptoms of GERD include regurgitation, vomiting, and heartburn." — Lizzie Lee (host_summary) [Ep 6 · 4:42](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=282)
- "Impedance is a tool used to measure reflux and distinguish between a swallow versus actual reflux." — Scott Pentik (clinical) [Ep 6 · 4:48](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=288)
- "Patients with eosinophilic esophagitis often have procedures performed on them even before their diagnosis." — Scott Pentik (clinical) [Ep 6 · 5:21](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=321)
- "Data shows an increase in airway surgery complications in patients who were later found to have eosinophilic esophagitis." — Lizzie Lee (host_summary) [Ep 6 · 5:28](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=328)
- "The center now performs endoscopy as part of workup prior to even considering surgery." — Scott Pentik (guideline) [Ep 6 · 5:35](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=335)
- "Anatomic issues in aerodigestive patients include strictures that need balloon dilations or stenting." — Lizzie Lee (host_summary) [Ep 6 · 5:40](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=340)
- "Kids will have Nissans and then have hernias later." — Scott Pentik (clinical) [Ep 6 · 5:49](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=349)
- "Motility issues after TEF repairs include narrowing of the esophagus and the esophagus not squeezing, leading to more reflux, more dysphagia, and impactions." — Scott Pentik (clinical) [Ep 6 · 5:58](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=358)
- "When 25 patients in the aerodigestive program were assessed, 76% of them had a feeding disorder." — Lizzie Lee (host_summary) [Ep 6 · 6:13](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=373)
- "Patients at risk for pulmonary insufficiency include preemies with chronic lung disease, patients with restrictive lung disease, congenital or acquired abnormalities, and heart disease like pulmonary hypertension." — Lizzie Lee (host_summary) [Ep 6 · 6:54](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=414)
- "Patients at risk for pulmonary insufficiency typically present with chronic symptoms including tachypnea, shortness of breath, retractions, non-apneic hypoxemia, and in older patients, exercise intolerance." — Sherry Torres Silva (clinical) [Ep 6 · 7:06](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=426)
- "Underlying pulmonary insufficiency should be suspected if patients have had complicated respiratory infections requiring positive pressure ventilation." — Lizzie Lee (host_summary) [Ep 6 · 7:20](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=440)
- "Patients at risk for chronic pulmonary aspiration include preemie babies, those with swallowing dysfunction, GI dysmotility, cardiothoracic esophageal and airway history, and syndromes including CHARGE syndrome, Mobius, Criducha, and trisomy." — Sherry Torres Silva (clinical) [Ep 6 · 7:32](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=452)
- "Risk factors for upper airway obstruction include airway abnormalities like mid-face hypoplasia, skeletal dysplasia, decreased muscle tone, and syndromes associated with airway obstruction." — Lizzie Lee (host_summary) [Ep 6 · 7:48](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=468)
- "Patients with airway obstruction, especially upper airway, will have symptoms with sleep and significant exertion or agitation, and noisy breathing might be one of the most significant symptoms reported." — Sherry Torres Silva (clinical) [Ep 6 · 8:02](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=482)
- "Risk factors for lower airway obstruction include acquired or congenital thoracic deformities and those who had thoracotomies done in the past." — Lizzie Lee (host_summary) [Ep 6 · 8:13](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=493)
- "Tracheomalacia is a very common comorbidity in patients with history of esophageal fistula or atresia." — Sherry Torres Silva (clinical) [Ep 6 · 8:22](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=502)
- "High-resolution CT is the gold standard for diagnosis because it is highly sensitive and detects early changes of the small airways, and 3D reconstructions can be performed." — Sherry Torres Silva (clinical) [Ep 6 · 8:36](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=516)
- "Flexible bronchoscopy is used starting in the nose and ending in the subsegmental bronchi, and bronchoalveolar lavage helps with identification of infections and markers of aspiration." — Sherry Torres Silva (clinical) [Ep 6 · 8:49](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=529)
- "Pulmonologists perform medical management of aspiration including control of sialorrhea, optimization of airway clearance, and use of anti-inflammatory medications for chronic aspiration or inflammation." — Sherry Torres Silva (clinical) [Ep 6 · 9:02](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=542)
- "For patients with ventilatory insufficiency, the pulmonologist determines if the child still needs ventilatory support and whether they are ready for decannulation." — Lizzie Lee (host_summary) [Ep 6 · 9:15](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=555)
- "The pulmonologist assesses how ready the patient is for weaning from the vent and whether they can start or advance feeding." — Lizzie Lee (host_summary) [Ep 6 · 9:26](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=566)
- "In the NICU, general surgeons obtain feeding access, manage anorectal malformations, and perform surgical procedures such as tracheopexies and lung resections." — Lizzie Lee (host_summary) [Ep 6 · 9:41](https://library.globalcastmd.com/watch/quad-27-multidisciplinary-how-do-teams-enhance-outcomes-by-the-cchmc-adec-team-10201?t=581)
- "Most children who aspirate have a functional or neurological problem (cerebral palsy, CHARGE syndrome); some have anatomical problems (TEF, laryngeal cleft, pharyngeal scar, esophageal stenosis)." — Michael Rutter (clinical) [Ep 1 · 4:39](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=279)
- "Lipid-laden macrophages are non-specific markers of aspiration; their recovery depends on the lipid content of aspirated material, the amount aspirated, and time since aspiration." — Bob Wood (clinical) [Ep 1 · 8:05](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=485)
- "Multi-channel intraluminal impedance testing detects reflux but does not diagnose aspiration; it tells you whether something is delivered from the stomach to the esophagus, not what happens after." — Phil Putnam (clinical) [Ep 1 · 9:38](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=578)
- "If a patient is aspirating from above (oropharyngeal or esophageal source), an anti-reflux procedure does not help and may make them worse." — Daniel von Allmen (clinical) [Ep 1 · 9:58](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=598)
- "A 3-French bugbee cautery is a smooth, excellent probe for identifying subtle tracheoesophageal fistulas." — Michael Rutter (clinical) [Ep 1 · 12:10](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=730)
- "A 70-degree endoscope is a difficult tool to use but can visualize TEFs that are otherwise hard to see with standard forward-viewing scopes." — Michael Rutter (clinical) [Ep 1 · 13:21](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=801)
- "Routine bronchoscopy is now standard practice for all type C TEF repairs at Cincinnati Children's, often done in collaboration with ENT colleagues." — Daniel von Allmen (clinical) [Ep 1 · 14:02](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=842)
- "Pediatric surgery fellows at Cincinnati Children's complete a one-month attachment with ENT to perform bronchoscopies and gain airway expertise." — Michael Rutter (clinical) [Ep 1 · 14:51](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=891)
- "Dual scoping (simultaneous bronchoscopy and esophagoscopy) allows scopes to 'shake hands' across a fistula, light transillumination through tissue, and injection of saline or air to reveal subtle openings." — Daniel von Allmen (clinical) [Ep 1 · 19:37](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1177)
- "A 2.8 mm flexible bronchoscope and a 5.4–6 mm infant gastroscope are the typical scopes used for combined airway-esophageal examination in small children." — Phil Putnam (clinical) [Ep 1 · 21:02](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1262)
- "Endoscopic TEF closure requires demucosalization of the tract (mucosa is a non-stick surface); the goal is raw-against-raw apposition with minimal fibrin glue (0.1 mL) to seal the tract while scarring occurs." — Michael Rutter (clinical) [Ep 1 · 23:41](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1421)
- "Endoscopic TEF repair success rate is approximately 80%, typically requiring 2 attempts; after 3–4 failed attempts, open repair should be considered." — Michael Rutter (clinical) [Ep 1 · 37:01](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2221)
- "Positive-pressure air insufflation (30 cm H₂O) via an endotracheal tube in the esophagus can reveal a TEF by causing air to bubble out of the tracheal opening." — Michael Rutter (clinical) [Ep 1 · 34:20](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2060)
- "Injection of an inert material (e.g., Radiesse voice gel) into the walls adjacent to a TEF tract can obliterate the potential space and promote raw-on-raw apposition; the material is absorbed over a few weeks." — Michael Rutter (clinical) [Ep 1 · 39:48](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2388)
- "Slide tracheoplasty for TEF involves transecting the trachea above and below the fistula, beveling the edges, turning in the tracheal wings to repair the esophagus, interposing sternal periosteum, and reconnecting the trachea; it is a three-layer repair." — Michael Rutter (clinical) [Ep 1 · 45:48](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2748)
- "Sternal periosteum is an excellent interposition graft material: it is abundant, in the surgical field, and extremely strong ('like Kevlar'), though difficult to suture." — Michael Rutter (clinical) [Ep 1 · 46:52](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2812)
- "Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification." — Michael Rutter (guideline) [Ep 1 · 53:37](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3217)
- "Button battery injuries in the esophagus can progress to aortoesophageal fistula; CT angiography and close follow-up for 6 weeks post-removal are recommended, especially if the battery was at the aortoesophageal junction." — Phil Putnam (guideline) [Ep 1 · 59:02](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3542)
- "Two slide tracheoplasty repairs for button battery TEF both dehisced (one at 10 days, one at 3 months); both were successfully revised. This may be more than coincidence, suggesting button battery injuries pose unique challenges." — Michael Rutter (clinical) [Ep 1 · 54:02](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3242)
- "Transtracheal TEF repair is a two-dimensional operation with lower complication risk than slide tracheoplasty; the primary complication is re-fistulization, whereas slide tracheoplasty dehiscence is a more serious event." — Michael Rutter (opinion) [Ep 1 · 69:04](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4144)
- "Transtracheal repair technique: anterior tracheotomy, identify the fistula from within the trachea, separate tracheal and esophageal layers, three-layer closure (esophageal mucosa with knots in lumen, sternal periosteum, tracheal wall with knots in lumen)." — Michael Rutter (clinical) [Ep 1 · 64:43](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=3883)
- "In patients with retroesophageal subclavian artery, the right recurrent laryngeal nerve is non-recurrent and at higher risk during neck dissection; awareness is critical during transtracheal or slide tracheoplasty approaches." — Michael Rutter (clinical) [Ep 1 · 94:43](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5683)
- "Flexible bronchoscopy cannot reliably diagnose laryngeal clefts; rigid microlaryngoscopy with active probing is mandatory when posterior glottic pathology is suspected." — Bob Wood (clinical) [Ep 1 · 116:27](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6987)
- "When examining the cervical trachea and subglottis with a flexible bronchoscope, it is easier to see pathology while slowly withdrawing the scope than while advancing it, due to the need to flex and extend the tip to navigate the glottis." — Bob Wood (clinical) [Ep 1 · 87:43](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5263)
- "Insufflation with oxygen at 2 L/min through the suction channel of a flexible bronchoscope spreads tissue apart, improves visualization, and does not impair respirations." — Bob Wood (clinical) [Ep 1 · 86:58](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5218)
- "The degree of angulation at the tip of a flexible bronchoscope is much greater in one direction (retroflexion) than the other; rotating the scope 180° (Sabode maneuver) can reveal posterior tracheal pathology more easily." — Bob Wood (clinical) [Ep 1 · 86:30](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5190)
- "Endoscopic closure of bronchoesophageal fistulas is feasible but challenging; proximity to large vessels (e.g., pulmonary artery branches) may preclude safe cautery and necessitate surgical resection." — Michael Rutter (clinical) [Ep 1 · 107:43](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6463)
- "In a patient with multiple bronchoesophageal fistulas and chronic bronchiectasis, lobectomy with resection of the esophageal pseudo-diverticulum can be performed safely; the esophagus can be primarily closed if not strictured." — Daniel von Allmen (clinical) [Ep 1 · 112:36](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6756)
- "A Y-shaped airway stent from both bronchi into the trachea, with the tracheostomy tube sitting within the stent, can effectively bypass a bronchoesophageal fistula and allow clinical stability when further repair is not feasible." — Michael Rutter (clinical) [Ep 1 · 100:56](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6056)
- "Tracheal pouches (diverticula) can be marsupialized endoscopically using a Storz ClickLine laparoscopic biopsy forceps with cautery at 40 watts; the technique is quick, well-tolerated, and eliminates the risk of tracheostomy tube misplacement." — Michael Rutter (clinical) [Ep 1 · 118:01](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=7081)
- "When cauterizing in the airway with a bugbee, oxygen concentration should be kept below 30% to minimize fire risk; brief periods of lower oxygen saturation are tolerable." — Michael Rutter (clinical) [Ep 1 · 38:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=2315)
- "A 3-French bugbee cautery fits through the 1.2 mm suction channel of a 2.8 mm flexible bronchoscope, allowing precise control and steering of the cautery tip." — Bob Wood (clinical) [Ep 1 · 27:54](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1674)
- "Trichloroacetic acid (TCA) can be used to demucosalize TEF tracts, but control is less precise than with bugbee cautery; TCA is applied on a pledget and can cause unintended burns if it contacts tissue during insertion." — Todd Ponsky (clinical) [Ep 1 · 25:08](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=1508)
- "Anal fistula plugs (biologic, cone-shaped, made of Surgisis) can theoretically be used to occlude distal airway fistulas; they are wrapped with barbed suture and inserted into the tract to promote collagen matrix formation and scarring." — Todd Ponsky (clinical) [Ep 1 · 110:04](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6604)
- "Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation; revision cases have been necessary as experience was gained." — Michael Rutter (opinion) [Ep 1 · 69:59](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4199)
- "After 7 years of aspiration through a TEF, a child may have significant bronchiectasis; repair of the fistula does not immediately resolve lower airway disease, and ongoing chest physiotherapy and airway clearance are required." — Michael Rutter (clinical) [Ep 1 · 95:23](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5723)
- "Hearing aid molds are radiolucent and can be missed on chest X-ray; high clinical suspicion is required when a foreign body ingestion is reported but not visualized." — Michael Rutter (clinical) [Ep 1 · 97:35](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5855)
- "Pectus excavatum can worsen tracheobronchomalacia; placement of a pectus bar can improve airway support and reduce the need for stenting or tracheostomy." — Michael Rutter (clinical) [Ep 1 · 99:49](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=5989)
- "Airway stents can erode into the esophagus, creating secondary fistulas; long-term stent management requires vigilance and may necessitate alternative strategies (e.g., Y-stent with tracheostomy tube within the stent)." — Michael Rutter (clinical) [Ep 1 · 100:32](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=6032)
- "When repairing a high TEF from a thoracic approach, ligation of the fistula on the esophageal side can leave a large tracheal pouch; if the patient has tracheomalacia and requires a tracheostomy, the tube may enter the pouch, causing life-threatening obstruction." — Michael Rutter (clinical) [Ep 1 · 77:21](https://library.globalcastmd.com/watch/aerodigestive-esophageal-surgery-difficult-tracheal-esophageal-fistula-739?t=4641)
- "At Cincinnati Children's, if a child has no gas in the abdomen, they place a G-tube and may put something up the distal esophagus for a fluoro shot, then wait a couple of weeks for a protocol gap measurement in interventional radiology." — Daniel von Allmen (clinical) [Ep 2 · 0:46](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=46)
- "In the Foker technique, the surgeon ties sutures to either end of the esophagus through an open incision, brings them out through the chest wall, ties them together in a knot, and places spacers underneath periodically (about every day) until the ends come together for primary anastomosis." — Rod Gerardo (host_summary) [Ep 2 · 1:08](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=68)
- "Stretch is a very strong promoter of growth, and if you put things on tension they will actually grow over time, which is how the cardiovascular system develops in utero." — Daniel von Allmen (clinical) [Ep 2 · 2:10](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130)
- "The philosophy of traction-based elongation is that with traction, you can get the two ends of the esophagus to grow, and if you can get them to grow far enough, you can put them together." — Daniel von Allmen (clinical) [Ep 2 · 2:10](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=130)
- "The van der Zee technique uses the same concept as Foker but is done thoracoscopically with no external sutures, so all tension is inside the thorax." — Rod Gerardo (host_summary) [Ep 2 · 2:39](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=159)
- "The Kimura technique involves creating a spit fistula and periodically moving it down the chest wall over time to stretch the proximal pouch closer to the distal pouch, but is not used all that often anymore." — Rod Gerardo (host_summary) [Ep 2 · 2:39](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=159)
- "In the Boston Group 2015 study, the primary group (de novo cases) achieved an intact esophagus in 96% of patients, while the secondary group (patients with previous operations) achieved this in about two thirds of patients." — Daniel von Allmen (host_summary) [Ep 2 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "In the Boston Group 2015 study, the primary group had a median ICU stay of 70 days with a couple of weeks being paralyzed, and the secondary group had a median ICU stay of 110 days with a month of being paralyzed." — Daniel von Allmen (host_summary) [Ep 2 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "In the Boston Group 2015 study, about two thirds of patients with primary repair were able to get full oral nutrition and about 10% of patients who had secondary repair achieved full oral nutrition." — Daniel von Allmen (host_summary) [Ep 2 · 3:15](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=195)
- "The surgical group from INOEA recommends gastric pull up as the first option for esophageal replacement, dividing the esophageal stump at the esophageal hiatus and mobilizing the fundus to pull it up in either the anterior or posterior mediastinum." — Daniel von Allmen (host_summary) [Ep 2 · 4:36](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276)
- "The colon can be used as an interposition for esophageal replacement." — Daniel von Allmen (clinical) [Ep 2 · 4:36](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=276)
- "In colonic interposition, the piece of colon chosen is based on the blood supply and the diameter needed." — Rod Gerardo (host_summary) [Ep 2 · 5:08](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308)
- "In colonic interposition, a pyloroplasty is performed to help with gastric emptying." — Rod Gerardo (host_summary) [Ep 2 · 5:08](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=308)
- "Common problems with colonic interposition are that the colon can dilate and become tortuous, and it's not uncommon to get a sigmoid sink drain deformity just above the diaphragm." — Daniel von Allmen (clinical) [Ep 2 · 8:00](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=480)
- "Von Allman was initially taught that sigmoid redundancy in colonic interposition can't be fixed and that it's too dangerous because it will risk the blood supply, but he found that this is not really true." — Daniel von Allmen (opinion) [Ep 2 · 8:17](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "Von Allman passes the colonic interposition posterior to the stomach, which leaves the vascular pedicle along the spine, allowing mobilization of the colon by dividing the gastric duodenotomy and colon attachment to the stomach, then mobilizing the sigmoid redundancy transhiatally and reanastomosing the colon to the stomach." — Daniel von Allmen (clinical) [Ep 2 · 8:17](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "Colonic interpositions sometimes need to be revised, but it is not impossible to revise them and the kids tend to do pretty well." — Daniel von Allmen (opinion) [Ep 2 · 8:17](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=497)
- "You can get extraordinary length with colonic interposition, allowing treatment of cases with caustic injuries extending to the pharynx by sewing the colon to the pharynx and down to the stomach, which is tough to do with a gastric pull-up." — Daniel von Allmen (clinical) [Ep 2 · 9:03](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=543)
- "The short interval between time of traction and anastomosis (less than five days) raises the question of whether the mechanism is stretching or growth, which will impact results and likely reflects on complications." — Rod Gerardo (host_summary) [Ep 2 · 9:27](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=567)
- "Von Allman states we don't know whether esophageal elongation is growth or stretch and should do studies to understand that, but notes that tension is a very good physiologic growth promoter in other organs, making this an area ripe for more basic science." — Daniel von Allmen (opinion) [Ep 2 · 9:56](https://library.globalcastmd.com/watch/treatment-for-long-gap-esophageal-atresia-esophageal-elongation-and-replacement-4791?t=596)
- "The azygous vein drains the bronchi, trachea, and esophagus, and its division may lead to impaired function postoperatively and impaired clearance of mucus and debris from the tracheobronchial tree" — Jose Campos (host_summary) [Ep 3 · 3:25](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=205)
- "In a meta-analysis of almost 700 neonates, preserving the azygous vein resulted in significantly lower postoperative pneumonitis compared to division" — Ellen Encisco (host_summary) [Ep 3 · 3:02](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=182)
- "There was no significant difference in anastomotic leak rate or stricture rate between azygous vein preservation and division" — Ellen Encisco (host_summary) [Ep 3 · 3:11](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=191)
- "The endpoint of chest infection in the azygous vein meta-analysis was not clearly defined across studies—some used 'chest infection,' some 'pneumonitis,' some 'pneumonia'—making it a non-homogeneous endpoint" — Jose Campos (clinical) [Ep 3 · 4:45](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=285)
- "In the Quebec study of 244 patients, the overall anastomotic stricture rate at one year was 30%" — Ellen Encisco (host_summary) [Ep 3 · 6:43](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=403)
- "36% of patients with transanastomotic tubes developed strictures compared to 19% without tubes, a difference that remained significant after multivariable analysis" — Ellen Encisco (host_summary) [Ep 3 · 6:50](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=410)
- "Patients with transanastomotic tubes had 2.72 times higher odds of developing a stricture compared to those without" — Ellen Encisco (host_summary) [Ep 3 · 7:06](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=426)
- "The Quebec study adjusted for gestational age, leak, length of gap, and tension, and still found almost 3 times higher stricture rates with transanastomotic tubes" — Jose Campos (host_summary) [Ep 3 · 7:32](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=452)
- "Patients with transanastomotic tubes started feeding on day 2 versus day 10 for those without tubes, but early feeding did not lead to less TPN—duration was 9 days in both groups" — Em Gootee (host_summary) [Ep 3 · 7:54](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=474)
- "Congenital esophageal stenosis is associated with esophageal atresia in 7% to 10% of cases and most are diagnosed really late, sometimes after the anastomosis fails" — Jose Campos (epidemiological) [Ep 3 · 9:44](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=584)
- "Passing a tube through the anastomosis to check for resistance can help identify distal esophageal stenosis intraoperatively" — Jose Campos (clinical) [Ep 3 · 9:58](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=598)
- "In a meta-analysis of about 500 newborns, there was no significant difference in leak occurrence, pneumothorax, or mortality based on whether a chest drain was placed" — Em Gootee (host_summary) [Ep 3 · 12:20](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=740)
- "The group that received a chest drain had a significantly higher chance of returning to the operating room" — Em Gootee (host_summary) [Ep 3 · 12:31](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=751)
- "If a leak occurs, it doesn't always drain through the chest tube" — Todd Ponsky (clinical) [Ep 3 · 11:23](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=683)
- "A chest tube may injure, suck on, or increase the chance of disruption of the anastomosis" — Todd Ponsky (opinion) [Ep 3 · 11:30](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=690)
- "Chest tubes are painful for patients" — Todd Ponsky (clinical) [Ep 3 · 11:39](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=699)
- "Giving acid suppression to neonates increases the risk of necrotizing enterocolitis according to neonatologists' concerns" — Todd Ponsky (host_summary) [Ep 3 · 13:41](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=821)
- "Giving PPIs to neonates can increase pneumonia in different populations, but the risk is very minimal" — Jose Campos (clinical) [Ep 3 · 14:24](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=864)
- "In the Midwest Pediatric Surgery Consortium study, antibiotics for more than 24 hours and acid suppression showed no difference in strictures or leaks" — Ellen Encisco (host_summary) [Ep 3 · 14:54](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=894)
- "Not giving antibiotics postoperatively helps detect complications early rather than having antibiotics cover a complication" — Jose Campos (clinical) [Ep 3 · 14:10](https://library.globalcastmd.com/watch/case-based-journal-review-esophageal-atresia-in-2022-5631?t=850)

## Changelog
- Sep 8: 1 item no longer name tracheoesophageal fistula
- Sep 7: 7 items added automatically

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