Collection
Esophageal Atresia and Tracheoesophageal Fistula
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
A 5 millimeter endoscopic clip was used to secure the fistula, which the surgeon prefers to suture ligation as it provides a very atraumatic and quick way to secure the fistula. Thoracoscopic Repair of a Type 3 Tracheoesophageal Fistula in a 2.6 kg Infant · 7:00
Thoracoscopic Esophageal Atresia Repair Tips & Tricks: Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course,Dr. Steven Rothenberg shares tips and tricks for thoracoscopic esophageal atresia repair. Discussion involves intraoperative ventilation, operating room layout, patient positioning, trocar p
video23:14 · Sep 2018
Rothenberg Thoracoscopic Technique Video: EA/TEF
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Dr. Steven Rothenberg reviews the basics of esophageal atresia, the current treatment modalities, the possible complications (and how they can be avoided), and tips and tricks for managing variations.
video9:19 · Jan 2019
Tips and Tricks: EA & TEF
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Dr. Steven Rothenberg leads a discussion on tips and tricks that are useful in operative and post-operative management of esophageal atresia and tracheoesophageal fistula.
video9:27 · Jan 2019
Thoracoscopic Repair of a Type 3 Tracheoesophageal Fistula in a 2.6 kg Infant
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Surgical content by Dr. Steve Rothenberg — Thoracic Surgery
video19:36 · May 2026
Thoracoscopic Tracheoesophageal Fistula Repair: Upper Pouch Mobilization and Anastomosis
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Surgical content by Dr. Steve Rothenberg — Thoracic Surgery
video2:05 · May 2026
Thoracoscopic Tracheoesophageal Fistula Repair
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Surgical content by Dr. Steve Rothenberg — Thoracic Surgery
video · May 2026
QUAD #10 Pt.1: History of Thoracoscopic Repair of Esophageal Atresia (EA) & Tracheoesophageal Fistula (TEF) with Dr. Steve Rothenberg
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In this video we explore the transformative benefits of thoracoscopic repair for esophageal atresia with Dr. Steve Rothenberg from Rocky Mountain Hospital for Children. This video covers:
Advocating for Minimally Invasive Surgery: The
video6:27 · Jun 2024
QUAD #10 Pt.2: Surgical Technique for Thoracoscopic Repair of Tracheoesophageal Fistula (TEF) with Dr. Steve Rothenberg
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In this video we’ll talk about minimally invasive thoracoscopic tracheoesophageal fistula (TEF) repair with Dr. Steve Rothenberg from Rocky Mountain Hospital for Children. This video covers:
Anesthesia: Using CO2 to collapse the lu
video · Jun 2024
QUAD #10 Pt.3: Advantages of Thoracoscopic Repair of Esophageal Atresia with Dr. Steve Rothenberg
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In this video we’ll talk about benefits of thoracoscopic tracheoesophageal fistula (TEF) repair in reducing tracheomalacia and improving patient outcomes with Dr. Steve Rothenberg from Rocky Mountain Hospital for Children. Here are some hig
video · Jun 2024
By International group classification, a gap of 4 centimeters or more is required to be considered long gap esophageal atresia. — Steven Rothenberg, Update Course 2021: MAGNET THERAPY FOR ESOPHAGEAL ATRESIA · 17:20
Long Gap Esophageal Atresia – How I Do It: Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course, Drs Daniel von Allmen, David van der Zee, Russell Jennings, Steve Rothenberg, Mac Harmon, Whit Holcomb, Todd Ponsky and Rachel Hankediscuss long gap esophageal atresia. Discussion involvese
video38:56 · Sep 2018
Long Gap Technique Videos: EA & TEF
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Dr. Arnold Coran discusses his management of long-gap esophageal atresia, and presents a video detailing his technique for measurement of the gap utilizing a neonatal endoscope.Dr. Steven Rothenberg shows a technique video detailing his ope
video17:51 · Jan 2019
Thoracoscopic Long-Gap Esophageal Atresia Repair
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Surgical content by Dr. Steve Rothenberg — General
video · May 2026
Update Course 2021: MAGNET THERAPY FOR ESOPHAGEAL ATRESIA
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At Pediactric Surgery Update Course 2021, Dr. Bethany Slater, MD from University of Chicago ComerChildren's Hospital and Dr. Steven Rothenberg, MD from Rocky Mountain Hospital for Children sharing their cases on using magnet therapy as an a
video · May 2022
Placing a catheter across the H-type fistula can occasionally be helpful for identification, though it was not used in this case. VATS H-Type Fistula Repair - Technique · 3:00
VATS H-Type Fistula Repair - Technique
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Dr. Steven Rothenberg describes his technique for thoracoscopic repair of an H-type tracheoesophageal fistula. Key steps to the procedure include opening of the apical pleura with a vessel sealer, identification of the esophagus and the tr
video4:36 · Nov 2018
IPEG 2018 - RIGHT THORACOSCOPIC REPAIR OF AN H-TYPE TRACHEOESOPHAGEAL FISTULA
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IPEG 2018 Annual Meeting
Right Thoracoscopic Repair of an H-Type Tracheoesophageal Fistula
Top 10 Abstract
S. Abdulhai, S. Rothenberg
video3:52 · Apr 2021
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Thoracoscopic repair has emerged as the preferred approach for esophageal atresia with tracheoesophageal fistula, offering superior visualization and reduced morbidity compared to thoracotomy, which carries a 30-40% risk of shoulder girdle weakness, chest wall asymmetry, and scoliosis . The technique uses CO2 insufflation for lung collapse without requiring single-lung ventilation, with patients positioned in 60-degree prone tilt and three ports placed for optimal visualization [e8704-c1, e8704-c4]. The critical technical element is extensive upper pouch mobilization, dissecting under direct vision to the posterior oropharynx to gain length, which has enabled primary repair in all type C cases at experienced centers [e8703-c5, e8703-c6, e8703-c7]. The fistula is clipped (or suture-ligated in infants <2 kg) but not immediately divided to avoid losing it during dissection [e8704-c11, e8704-c14]. Complete amputation of the upper pouch tip is now standard after early experience showed partial opening increased stricture rates [e8704-c6, e8704-c7]. A single-layer anastomosis with 4-0 or 5-0 PDS uses full-thickness bites with posterior knots placed intraluminally; transanastomotic tubes are no longer used due to higher stricture rates [e8704-c8, e8704-c16, e8704-c20]. Outcomes include 3% leak rate (all managed conservatively), 16% stricture rate, one recurrent fistula, and 25% requiring fundoplication, with no mortality directly attributable to repair [e8704-c23, e8704-c24, e8704-c25, e8704-c26, e8704-c27]. For H-type fistulas at the thoracic inlet, thoracoscopic division with stapler and tissue interposition avoids neck dissection and reduces iatrogenic tracheomalacia [e8703-c12, e8703-c15, e8703-c16]. Magnetic compression anastomosis (Flourish device) is reserved for gaps >4 cm in pure EA or previously repaired fistula, but all patients develop strictures and the technique has significant complications including acquired fistula formation [e5416-c4, e5416-c5, e5416-c6, e5416-c11].
- Extensive upper pouch mobilization to the posterior oropharynx is the key maneuver enabling primary thoracoscopic repair in all type C cases, even with six vertebral body gaps. [e8703-c5, e8703-c6, e8703-c9]
- Sharp dissection only between upper pouch and membranous trachea prevents acquired TEF; cautery in this plane causes tracheal holes that are very difficult to repair. [e1075-c3, e1075-c4]
- Transanastomotic tubes increase stricture rates and are no longer recommended; complete upper pouch amputation (vs. slit) also reduces strictures. [e8704-c6, e8704-c20]
- Thoracoscopic repair achieves 3% leak rate (all conservatively managed), 16% stricture rate, and eliminates thoracotomy morbidity (scoliosis, chest wall deformity). [e8704-c23, e8704-c25, e8704-c22]
- Fistula clipping without division risks recanalization; if clipping for staged repair, divide the fistula and tack distal segment to prevertebral fascia. [e1075-c19, e1075-c20, e1075-c21]
For patients & families
Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are birth defects where the esophagus doesn't form properly and may have an abnormal connection to the windpipe. Doctors now often repair these conditions using a minimally invasive approach called thoracoscopic surgery, which uses small incisions and a camera instead of opening the chest widely . This newer technique helps avoid complications like chest wall problems and shoulder weakness that can happen with traditional open surgery . During the repair, surgeons carefully separate the esophagus from the windpipe, close any abnormal connections, and reconnect the esophagus so the baby can swallow normally [e8704-c10, e8704-c16]. The key to success is gently stretching the upper part of the esophagus to reach the lower part, which doctors can see very clearly with the camera [e8704-c12, e8704-c13]. Most babies recover well—they typically have a special X-ray test four days after surgery, and if everything looks good, they can start eating [e8704-c21, e11923-c23]. Some children may need their esophagus stretched later if it becomes narrow, and some may need treatment for acid reflux [e8704-c25, e8704-c26]. The thoracoscopic approach leaves almost no visible scars and doesn't cause the chest wall shape problems that older surgery methods sometimes did .
Esophageal atresia (EA) and tracheoesophageal fistula (TEF) are birth defects where the esophagus doesn't form properly and may have an abnormal connection to the windpipe. Doctors now often repair these conditions using a minimally invasive approach called thoracoscopic surgery, which uses small incisions and a camera instead of opening the chest widely . This newer technique helps avoid complications like chest wall problems and shoulder weakness that can happen with traditional open surgery . During the repair, surgeons carefully separate the esophagus from the windpipe, close any abnormal connections, and reconnect the esophagus so the baby can swallow normally [e8704-c10, e8704-c16]. The key to success is gently stretching the upper part of the esophagus to reach the lower part, which doctors can see very clearly with the camera [e8704-c12, e8704-c13]. Most babies recover well—they typically have a special X-ray test four days after surgery, and if everything looks good, they can start eating [e8704-c21, e11923-c23]. Some children may need their esophagus stretched later if it becomes narrow, and some may need treatment for acid reflux [e8704-c25, e8704-c26]. The thoracoscopic approach leaves almost no visible scars and doesn't cause the chest wall shape problems that older surgery methods sometimes did .
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VATS H-Type Fistula Repair - Technique
The patient was a 3-month-old infant with multiple medical issues who had recurrent aspiration.
Host summaryThe host summarizing a resource — not the host's own clinical position0:00 ↗
Upper GI study showed an H-type tracheoesophageal fistula.
Host summaryThe host summarizing a resource — not the host's own clinical position0:30 ↗
There were 2 prior attempts at endoluminal ablation before this thoracoscopic repair.
Host summaryThe host summarizing a resource — not the host's own clinical position0:45 ↗
For thoracoscopic H-type fistula repair, the patient is placed in modified lateral decubitus position rolled prone approximately 45 degrees.
clinical1:00 ↗
Three ports were used: one 4 mm port (later advanced to 5 mm) and two 3 mm ports.
clinical1:30 ↗
A 4 mm 30-degree lens was used for the procedure and placed behind the tip of the scapula.
clinical1:45 ↗
The procedure starts in the apex using a 3 mm vessel sealer for dissection and to open the pleura.
clinical2:00 ↗
Developing a plane between esophagus and trachea below the level of the fistula is an important maneuver to help safely separate the two structures before encountering the very adherent area.
clinical2:30 ↗
Placing a catheter across the H-type fistula can occasionally be helpful for identification, though it was not used in this case.
opinion3:00 ↗
A 3 mm hook cautery was used to pull on fibers and separate them away from critical structures.
clinical3:15 ↗
Dissection is carried out above the fistula so that a retro-fistula plane can be developed.
clinical3:30 ↗
An instrument is passed around behind the fistula, taking care not to injure the esophagus or membranous portion of the trachea.
clinical3:45 ↗
A 2-0 silk suture is passed around the fistula to help with retraction.
clinical4:00 ↗
Previously, the technique involved dividing the fistula and then oversewing the two ends.
clinical4:15 ↗
In this case, with the child large enough and availability of a 5 mm stapler, a decision was made to use the stapler to divide the fistula.
clinical4:30 ↗
Care must be taken to ensure the recurrent laryngeal nerve and other important structures are not within the field of dissection.
clinical4:45 ↗
The lower port in the posterior axillary line was enlarged to 5 mm to accommodate the stapler.
clinical5:00 ↗
A single application of the 5 mm stapler divided the fistula, placing two rows of staples on either side.
clinical5:15 ↗
Apical fat is taken and sewn down to cover the esophageal end of the staple line to help separate the two staple lines and prevent recurrent fistulization.
clinical5:30 ↗
The pleura is closed over the divided fistula so that any leak would remain contained.
clinical5:45 ↗
The lung was re-expanded and no chest tube was left.
clinical6:00 ↗
The patient was examined at 2 weeks postoperatively and the fistula was assessed at 3 months.
Host summaryThe host summarizing a resource — not the host's own clinical position4:36 ↗
Tips and Tricks: EA & TEF
Spitz uses a 6 French feeding tube (not a Replogle) across the anastomosis to feed the baby for the first few days after operation.
clinicalSpitz0:04 ↗
Jack leaves a 5 French feeding tube across the anastomosis, both for feeding and to protect the back wall during the anastomosis.
clinicalJack0:18 ↗
Using cautery to dissect the plane between the membranous trachea and the medial wall of the upper esophageal pouch can result in holes in the membranous trachea, leading to an acquired tracheoesophageal fistula that is very difficult to fix.
clinical1:35 ↗
Sharp dissection is the only safe way to dissect the upper pouch off the membranous trachea; cautery should never be used in that particular plane.
clinical1:35 ↗
Steve uses blunt and sharp dissection when separating the upper pouch from the membranous trachea, only using cautery when he can clearly see the tissues and knows he is not injuring the membranous trachea.
clinicalSteve1:10 ↗
It is very hard to tie an extracorporeal knot with Vicryl suture.
clinicalSteve2:41 ↗
If tying extracorporeally, PDS should be used instead of Vicryl because it slides better.
clinicalSteve2:41 ↗
When there is an anastomosis under tension and concern about a leak, it is a good idea to get some tissue between the two suture lines to prevent development of a recurrent fistula.
clinical3:19 ↗
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