Abstract： Objective To evaluate the accuracy of preoperative ultrasonography (US) in depicting the structure of esophageal atresia with tracheoesophageal fistula (EA-TEF)and determine its role in planning surgical strategy by digitally measuring interpouch distance (ID).Methods A total of 1 8 neonates (10 males,8 females)with congenital EA-TEF were recruited.After obtaining chest radiographs with a coiled nasogastric tube in upper esophageal pouch,longitudinal esophageal high-frequency US was performed.The esophageal structures were displayed and the IDs measured on US images were compared with the surgical findings.The esophageal structures were displayed,and the IDs measured on US images were compared with the surgical findings.Results With the use of US, the structure of EA-TEF was accurately depicted.And the IDs detected by US correlated well with the surgical findings.Statistical analysis demonstrated no significant difference in the IDs as assessed by US and surgery (0.1-3.5 vs 0.1-3.6 cm)(R =0.99,P <0.01 ).Conclusions Preoperative US may provide more accurate information on the structure of EA-TEF and it plays a crucial role in planning surgical strategy.