The intraoperative localization in recurrent tracheoesophageal fistula after esophageal atresia repair: a comparative study

Abstract

Background Recurrent tracheoesophageal fistula (rTEF) is a rare complication following initial esophageal atresia (EA) surgical repair, posing challenges in localization the fistula during surgery due to severe thoracic adhesions and structural ambiguity from previous operations. Objective We introduced two new localization methods for rTEF patients during surgery and aimed to compare the impact of using these localization techniques versus not using them on the surgical outcomes for rTEF patients. Methods We retrospectively analyzed the clinical data of rTEF cases that underwent thoracoscopic repair at our hospital from September 2017 to December 2024. Patients were divided into localization group and non-localization group based on whether using intraoperative localization techniques, and comparative analysis of clinical variables was conducted between groups. Results A total of 106 patients were included in this study, undergoing a total of 113 thoracoscopic rTEF repair surgeries at our center. Their fistula type included 89 cases of tracheoesophageal fistula (TEF), 19 cases of esophageal-pulmonary fistula (EPF), 3 cases of esophageal bronchial fistula (EBF), and 2 cases of combined EPF and TEF. All cases were categorized based on whether using localization techniques, resulting in the localization group ( n = 52) and the non-localization group ( n = 61). The median operation time in the localization group (2.5 h) was significantly lower than in the latter (3.0 h) ( P = 0.001), and regardless of the fistula type being TEF or EPF. Additionally, the average postoperative hospital stay was significantly shorter in the localization group (17.7 ± 7.5 days) than in the non-localization group (23.6 ± 20.0 days) regarding the fistula type of TEF ( P = 0.03). Conclusions The use of localization techniques in thoracoscopic surgery for rTEF leads to better outcomes, evidenced by reduced operation time and hospital stay, suggesting enhanced surgical accuracy and improved patient postoperative recovery. Level of evidence LEVEL III.