Tuesday, April 15, 2008

Surgical Consult

We met with Dr Roger Pitt today to discuss the surgery that baby Quinlan will require and the resulting aftercare. He was extremely nice and walked us through all of the possible variations of EA/TEF with their corresponding surgical options.

The baby has either type C or type D. We are hopeful that it is the more common type C because the gap between the two ends of the esophagus is typically smaller making it easier to reattach them. If the gap is larger (uncommon with type C but common with type D) then we have to consider other options including traction or interposition grafts. We won't know which type he has until after he is born.

He will have surgery within 24-48 hours of birth to attempt to reconnect the esophagus. The esophagus will be given approximately one week to heal while the baby is fed intraveneously. Then we will try to feed the baby a small amount of milk and check for leaks (a tube will be left in his throat to provide drainage). If the suture doesn't leak and there are no complications the best possible outcome would be that he is home about 2 weeks after birth. A more conservative estimate may be 3-5 weeks.

After he comes home we will likely need to come back for periodic dilations where they will attempt to get the lower portion of the esophagus to stretch to the same size as the upper portion to which it was attached.

The biggest concern for me at the moment is that EA/TEF patients often suffer from one or more additional VACTERL birth defects. Each additional defect obviously comes with it's own set of challenges. The good news is that none of these additional defects have been observed in the ultrasounds so far (although they cannot see all of them).

Assuming that nothing changes overnight Kristen should be discharged from the hospital after her followup ultrasound tomorrow. She will then need to have weekly appointments at both the OBGYN and the hospital (ultrasound) until she gives birth.

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