Operative techniqueEndoscopic management of recurrent tracheoesophageal fistula
Section snippets
Methods
With approval from the institutional review board, a retrospective chart review of all patients undergoing endoscopic closure of RTEF (2003-2007) was performed at a single tertiary care pediatric institution. Patients referred to our institution were identified by pediatric otolaryngology and general surgery teams based on clinical suspicion and symptoms after open tracheoesophageal fistula closure. Esophograms were conducted on each patient to assist in diagnosis (Fig. 1A). Patient
Results
Four patients after primary tracheoesophageal repair underwent endoscopic RTEF obliteration at our institution between 2003 and 2007. Each patient had undergone prior repair of a proximal esophageal atresia with a distal TEF. Average time to discovery was 9.5 months (range, 2-19 months). Presenting symptoms were variable but consistent with persistent airway complaints after primary repair (Table 1). Recurrent wheezing, coughing and cyanosis with feeds, and evidence of persistent pnuemonitis
Discussion
Five anatomic variations of TEF exist. The most common presentation is distal TEF with proximal esophageal atresia (84%-88%). Repairs are performed shortly after birth with a relative recurrence rate of 3% to 20% depending upon surgical technique and TEF type [1], [3], [4], [21], [22], [23], [24]. Symptomatic clues of RTEF include coughing, wheezing, and cyanosis with feeding. However, subtle airway complaints or signs of persistent pnuemonitis despite antibiotic and reflux management most
Conclusion
Recurrent tracheoesophageal fistula after primary TEF repair is a rare but difficult complication. Increased morbidity and mortality rates have been reported during open revision cases of RTEF. The advent of endoscopic techniques for both pediatric otolaryngologists and general surgeons has provided a potential avenue for reducing perioperative morbidity and recurrence after open RTEF repair. Various endoscopic techniques have been used. Both the use of tissue adhesives and denuding the fistula
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2021, Journal of Pediatric SurgeryCitation Excerpt :Patients in our cohort presented consistent TEF symptoms with those reported in the literature [2,3]. Although an esophagram was performed, it was not considered for fistula diagnosis because of its low negative predictive value [1,3,13]. To diagnose a TEF, a laryngo-tracheal endoscopy was systematically performed, which is the current gold standard [3].
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Delivered as podium presentation at the Society for Ear, Nose, and Throat Advances in Children meeting in San Francisco, December 2006.