Recurrent tracheoesophageal fistula

Endoscopic management of recurrent congenital tracheoesophageal fistula: A review of techniques and results

“…The recurrence may present years after primary repair suggesting that recurrent TEF can be asymptomatic and/or difficult to diagnose [2,8]. Endoscopy and esophagram are the primary diagnostic methods, although each of these methods has failures and multiple examinations are usually required to confirm the diagnosis [8,11,13]. Still, most authors agree that bronchoscopy is essential for diagnosis [9,13,14].…”

“…Early reports of 50-60% perioperative mortality with secondary open repair for recurrent TEF have been reduced to 0-2% in some studies [2,8,11,13]. This is largely due to improved perioperative intensive care management of highrisk patients [5,6].…”

“…In 1960, Moskovitz presented a case report and review of the literature. He attributed low reporting of this complication to the difficulty in diagnosis and speculated that many cases of recurrent pneumonitis and dysphagia were due to undiagnosed recurrent TEFs [11].…”

“…Some authors argue that recannulization of an inadequately ligated fistula is the primary mechanism [7]. Factors leading to this tissue damage and/or recannulization include anastomotic leak, suture line erosion, anastomotic tension, gastroesophageal reflux (GERD), and mechanical trauma from early dilation [1,2,4,11,12].…”

Management of Recurrent Tracheoesophageal Fistulas: A Systematic Review

“…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. 48 The postoperative care is similar to after an ET.…”