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

Abstract

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.

A complicated tale of an acquired tracheoesophageal fistula: A case report

“…[6] Patients with recurrent TEF present with non-resolving cough, choking and apnea during feeds, recurrent pneumonia and if neglected may result in chronic lung disease. [1,5,6,7] The age at presentation has been reported as 3 weeks to 32 years. [5,6] Recurrent TEF after primary repair of EA with distal TEF has been found as a sequela of mediastinal abscess because of leaked anastomosis or esophageal perforation after forceful dilatation of anastomotic stricture.…”

“…[5,8] Some studies have also shown an association between premature birth, low birth weight, anastomotic stricture, and esophageal dilatation with recurrent TEF. [1] Long-gap atresia, usage of ligation (as opposed to transfixing suture), and long mean hospital stay have also been reported to be associated with recurrent TEF. [1,3] In agreement, members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) put forward a consensus statement to use a transfixing suture to close the TEF.…”

“…[1] Long-gap atresia, usage of ligation (as opposed to transfixing suture), and long mean hospital stay have also been reported to be associated with recurrent TEF. [1,3] In agreement, members of the European Reference Network for Rare Inherited Congenital Anomalies (ERNICA) put forward a consensus statement to use a transfixing suture to close the TEF. [9] The association of anastomotic stricture and involvement of esophageal anastomosis in acquired TEF highlights the issues with esophageal anastomosis in patients with esophago-pulmonary fistula.…”

“…Esophageal atresia (EA) with tracheoesophageal fistula (TEF) is a common congenital anomaly with an incidence of 1:2500 to 1:4500. [1,2] The most common variety is type C with the division of TEF and primary end-to-end anastomosis as the standard treatment. [2] The survival in most of the dedicated pediatric surgical centers is more than 90% with improvement in results attributed to improvement in perinatal care and surgical techniques.…”

Distal Recurrent Tracheoesophageal Fistula after Repair of Esophageal Atresia—Incidence, Risk Factors, and Outcome

“…It is believed that anastomotic leakage, AS, anastomotic rupture during stricture dilatation, and indwelling esophageal foreign body increase the risk of RTEF. [3][4][5][6] RTEF may present as choking, cough or cyanosis during feeding, recurrent pneumoniae, or chronic copious production of mucus. Diagnosis of RTEF is based on symptoms, endoscopy, and radiological imaging that include computed tomography (CT) scan and supine esophageal contrast examination.…”