Recommunication on Repair of Congenital Tracheoesophageal Fistula

Management of Recurrent Tracheoesophageal Fistulas: A Systematic Review

“…4,24,28,37 A prone esophagram performed by injecting the contrast under pressure via an NG tube while withdrawing the tube is the most sensitive investigation with the least false negatives. 4,35,50 The diagnosis is confirmed at bronchoscopy or esophagoscopy occasionally requiring the aid of methylene blue. 7,26,31,32 Important differentials are tracheal diverticula 51 or a missed second fistula.…”

“…[31][32][33] Depending on the level of the fistula an anterior neck crease or right thoracotomy is used to safely ligate the fistula, and suture the ends of the esophagus and trachea. 4,[34][35][36][37] Some have used a left extrapleural approach, 38 a transcervical transtracheal approach, 39 or via a median sternotomy. 40 Many authors recommend placement of an interposition tissue between the sutured ends of the esophagus and trachea to prevent a second recurrence; these include mediastinal pleura, [41][42][43][44][45] vascularized pedicle of pericardium, 31,32,46 pedicled sternocleidomastoid flap, 40 coastal cartilage graft, 47 and omental flaps.…”