Recurrent Tracheoesophageal Fistula

Lal, Dave R.; Oldham, Keith T.

doi:10.1055/s-0033-1347913

Cited by 32 publications

(3 citation statements)

References 36 publications

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“…However, these symptoms may also appear due to other complications after the operation of EA/TEF, such as esophageal stricture or gastroesophageal reflux. It is difficult to diagnose rTEF by symptoms alone and it is usually necessary to rely on auxiliary examinations such as bronchoscopy, esophagography, and esophageal gastroscopy to form a diagnosis ( 4 , 5 ). Repairing rTEF through thoracotomy or thoracoscopic surgery is the most reliable treatment, but it can also be treated using endoscopic therapies, tissue adhesives or de-epithelializing agents ( 4 , 5 ).…”

Section: Discussionmentioning

confidence: 99%

“…It is difficult to diagnose rTEF by symptoms alone and it is usually necessary to rely on auxiliary examinations such as bronchoscopy, esophagography, and esophageal gastroscopy to form a diagnosis ( 4 , 5 ). Repairing rTEF through thoracotomy or thoracoscopic surgery is the most reliable treatment, but it can also be treated using endoscopic therapies, tissue adhesives or de-epithelializing agents ( 4 , 5 ). Conservative treatment is generally required, and surgery is performed when the child's lung infection and systemic nutritional status permits ( 3 , 6 ).…”

Section: Discussionmentioning

confidence: 99%

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Risk Factors for Recurrent Tracheoesophageal Fistula After Gross Type C Esophageal Atresia Repair

Shen

Liu

et al. 2021

Front. Pediatr.

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Background: To determine the possible risk factors of recurrent tracheoesophageal fistula (rTEF) after Gross type C esophageal atresia (EA) and tracheoesophageal fistula (TEF) repair.Methods: The medical records of 343 pediatric patients with Gross type C EA/TEF who underwent surgical repair were retrospectively analyzed. The patients were retrospectively divided into two groups according to whether they had rTEF. Univariate and multivariable logistic regression analysis were performed to identify risk factors for rTEF.Results: After the diagnosis of EA/TEF, 343 patients (221 boys) underwent primary repairs after birth. According to the follow-up results (257 patients survived, 42 died, and 43 were lost to follow-up), 259 patients (257 survived and two died after rTEF repair) were included in the analysis. rTEF occurred in 33 patients (33/259, 12.74%), with a median onset time to recurrence of 3.8 (2.2, 8.2) months. Multivariate analysis showed that closing the original TEF with ligation and hospital stay ≥ 28.5 days were significant risk factors of rTEF with OR of 4.083 (1.481, 11.261) and 3.228 (1.431, 7.282).Conclusions: Surgical closure technique of original TEF and the length of initial stay could influence the occurrence of rTEF after Gross type C EA/TEF repair.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Risk Factors for Recurrent Tracheoesophageal Fistula After Gross Type C Esophageal Atresia Repair

Shen

Liu

et al. 2021

Front. Pediatr.

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“…On the other hand, endoscopic treatment is the least invasive. For endoscopy, the success rates vary significantly between studies from 37% to 100% in small series [1,[21][22][23]. Although there are publications with encouraging results, in our presented cases, the endoscopic attempts failed.…”

Section: Discussionmentioning

confidence: 66%

Novel Left-Sided Thoracoscopic Approach to Recurrent Tracheoesophageal Fistula and Post-Fistula Tracheal Diverticula

Patkowski,

Toczewski,

Ergun

2023

JCM

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Background: Recurrent tracheoesophageal fistula (RTEF) is usually a consequence of leakage or other complications after esophageal atresia repair performed through right-sided access. This results in extensive intrapleural adhesions, and open redo surgery poses a challenge. Alternatively, endoscopic endotracheal fistula obliteration usually requires repetitive procedures, and its success rate varies significantly between centers. We present a novel approach to recurrent fistulas. The innovation is in reaching the fistula through the virgin field via left-sided three-port thoracoscopy instead of classical right-sided thoracotomy. Methods: This is a presentation of a new operative technique based on a retrospective case series of patients operated on at our department between 2016 and 2023. Results: Eight patients after esophageal atresia repair (six with RTEF and two with post-fistula tracheal diverticula) were successfully treated with left-sided thoracoscopy. There were no conversions. One patient required rethoracoscopy for chylothorax. Another one, after RTEF closure, underwent multiple endoscopic obliterations of subsequent tracheal diverticulum. No other major complications nor re-recurrences were noted. Conclusions: Left-sided thoracoscopy in redo esophageal atresia has the advantage of a “virgin” operative field and grants feasible access to the RTEF or tracheal diverticulum. We believe that this approach is worth further exploration because it combines minimal invasiveness with high effectiveness without all the consequences of a thoracotomy.

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Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas

et al. 2021

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Objectives/Hypothesis: Repair of large, recurrent, and complex tracheoesophageal fistulas (TEFs) is challenging and numerous different surgical approaches exist. These various techniques each carry a set of risks and possible complications such as fistula recurrence, tracheal stenosis or pouches, esophageal stenosis, and recurrent laryngeal nerve injury. Slide tracheoplasty is a reconstructive technique successfully used in many different airway pathologies, including TEF repair. This study examines the success, limits, and complications related to slide tracheoplasty for repair of complex TEFs.Study Design: Retrospective chart review. Methods: Patients undergoing TEF repair using a cervical or thoracic approach slide tracheoplasty, at a single institution, between July 2008 and December 2019 were retrospectively reviewed. Demographic data, comorbidities, TEF etiology and surgical history, slide tracheoplasty details and outcomes, and postoperative complication data were examined using descriptive statistics.Results: Twenty-six patients underwent 27 slide tracheoplasties for TEF (20 cervical approaches, 7 thoracic approaches) with a mean age of 5.2 years (IQR 0.7-7.6) at time of surgery. The most common TEF etiologies included congenital (n = 13), tracheostomy tube erosion (n = 5), and button battery ingestion (n = 4). Fistulas ranged in size from <0.5 mm to 4 cm and 59% had previous endoscopic or open repairs. There were two TEF recurrences (7.4%), one of which was successfully revised and the other which was treated with stent placement. Postoperative complications included dehiscence (3.7%), unilateral vocal fold paralysis (3.7%), and mild tracheal stenosis (18.5%).Conclusions: Slide tracheoplasty is an effective surgical technique for treating complex congenital and acquired TEFs with lower rates of complications when compared to other techniques.

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Recurrent Tracheoesophageal Fistula

Cited by 32 publications

References 36 publications

Risk Factors for Recurrent Tracheoesophageal Fistula After Gross Type C Esophageal Atresia Repair

Risk Factors for Recurrent Tracheoesophageal Fistula After Gross Type C Esophageal Atresia Repair

Novel Left-Sided Thoracoscopic Approach to Recurrent Tracheoesophageal Fistula and Post-Fistula Tracheal Diverticula

Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas

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