title: Management of patients with combined tracheoesophageal fistula, esophageal atresia, and duodenal atresia.
abstract: BACKGROUND
  Patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia (DA) pose a rare management challenge.
  
  
  METHODS
  Three patients with combined esophageal atresia (EA), tracheoesophageal fistula (TEF), and duodenal atresia safely underwent a staged approach inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week. None of the patients suffered significant pre- or post-operative complications and our follow-up data (between 12 and 24 months) suggest that all patients eventually outgrow their reflux and respiratory symptoms.
  
  
  CONCLUSIONS
  While some authors support repair of all defects in one surgery, we recommend a staged approach. A gastrostomy tube is placed first for gastric decompression before TEF ligation and EA repair can be safely undertaken. The repair of the DA can then be performed within 3-7 days under controlled circumstances.
  
  
  CONCLUSIONS
  A staged approach of inserting a gastrostomy tube and repairing the EA/TEF first followed by a duodenoduodenostomy within one week resulted in excellent outcomes.
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States.
authors.forename: Christoph S
authors.initials: CS
authors.lastname: Nabzdyk
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States. Electronic address: bchiu@tuftsmedicalcenter.org.
authors.forename: Bill
authors.initials: B
authors.lastname: Chiu
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States.
authors.forename: Carl-Christian
authors.initials: CC
authors.lastname: Jackson
authors.affiliation: Division of Pediatric Surgery, Department of Surgery, Floating Hospital for Children at Tufts Medical Center, Tufts University School of Medicine, Boston, MA, United States.
authors.forename: Walter J
authors.initials: WJ
authors.lastname: Chwals
keywords: Duodenal atresia; Esophageal atresia; Surgical management; Tracheo-esophageal fistula