QUAD #12 Utilizing ENT for Cervical Approach in Esophageal Atresia (EA) Repair with Dr. Matt Smith

GlobalCast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe. Hello everyone. This is Kim Prevn and I'd like to welcome you back to the continuation of our quad series. In October 2022, Cincinnati Children's hosted the quad conference, which was a combination of four conferences. The International Organization for Esophageal Atresia, the Air Digestive Society Conference, the Cincinnati Children's Airway Course, and the Cincinnati Children's Pediatric Dysphagia Series. Today, we are going to hear from Dr. Matt Smith, an ENT surgeon at Cincinnati Children's, on the utilization of ENT or cervical approach for the repair of Esophageal Atresia. When it comes to an approach to Esophageal Atresia, we have teams made up of pediatric surgeons, ENTs, GIs, pulmonary, speech therapy and nutrition. How do you recommend we best utilize a diverse skill set in order to get the best outcomes for our patients? As a ear, nose and throat surgeon, I'm looking at that child not only from a future swallowing standpoint, but I'm also looking what's going on with the recurrent laryngeal nerve and is there any potential injury to that afterwards that we might need to help out with. We want to support each other. Most importantly, they need to get together with all of the specialists who are excellent at certain aspects of the child's care in order to maximize the results for the patients. And so when we do a cervical approach for Esophageal Atresia, and in regards to a colonic interposition, we will typically isolate the cervical trachea, avoiding injury to the recurrent laryngeal nerve and identifying it, isolating the cervical esophagus and freeing up soft tissue attachments. If the surgeons find that there are any tracheoesophageal fistulas present, they will divide and ligate them at that time. They then create a tunnel in the posterior mediastinum to connect to the abdomen. One of the benefits that we found is that we can actually do both sides of the operation at the same time. So while Dan is in the uh abdomen harvesting the colonic interposition graft, I can be up at the top of the table in the neck and isolate the esophagus for him and start that posterior mediastinal dissection. Here is a young child who had a prior Esophageal Atresia repair. Unfortunately, he ended up having a second tracheoesophageal fistula and required another surgery to hopefully fix it for good. We've got the trachea isolated here with Penroses. We've got the distal esophagus right here with the complete stricture that's closed off just distally here. We've divided now that TEF and that distal esophagus is ready to be used. So you may ask, why should we utilize an ENT surgeon? Then answer is an easy one as their intimate knowledge of head and neck anatomy and vast experiences in all aspects of complex airway management and surgery makes them really important in the success of these patients, especially our airway team at Cincinnati Children's. We are in the neck and doing a lot of airway operations all the time. It can help improve delivery of care, improve outcomes and decrease operative times. If there are complications with voice and even potentially swallowing in the future, it's important to have your ENT colleagues involved as soon as possible to have a hand in starting the cervical surgical approach. Don't forget to subscribe to the Stay Current MD YouTube channel. Follow our social media channels and download the Stay Current MD app for tons of content in pediatric surgery. GlobalCast MD, along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.