Looking back on the near 100% mortality in the repair of neo-natal Tracheo Oesophageal Fistula, in Kandy in the 1980s, I took a new approach. The steps were:-
1. Create an end oesophagostomy at the neck to divert the swallowed saliva, early after birth.
2.
Create a gastrostomy with a tie at the gastro-oesophageal junction
after birth. The milk feeds were given via the gastrostomy tube..
3.
After 6 months of the child's growth, I mobilized the stomach, brought
it via a subcutaneous tunnel and anastomosed it to the neck
oesophagostomy opening. The subcutaneous route was chosen so that lung function was not compromised by the presence of the stomach in the small chest cavity
You see a plump child after all the surgery in the 1980s, in the photos attached.
This is a good technique to practice in under-developed countries.
Dr,Philip Veerasingam, Consultant Surgeon.
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