Global Surgery Article
Recurrent and acquired tracheoesophageal fistulae (TEF)—Minimally invasive management

https://doi.org/10.1016/j.jpedsurg.2017.03.048Get rights and content

Abstract

Objective

Recurrent and acquired fistulae are a serious complication of congenital esophageal atresia and tracheoesophageal fistula (TEF) repair and foreign body ingestion (FBI) (e.g., button battery). We report our experience with a minimally invasive approach to recurrent and acquired TEF.

Methods

Medical records of patients referred for management of recurrent and acquired TEF between 2003 and 2015 were reviewed retrospectively. Patients underwent endoscopic procedures (de-epithelization of fistulous tract and fibrin tissue adhesive-TisseelR) under general anesthesia.

Results

Nine children (7 male, 2 female) with age range 3 months to 3 years (mean 1.5 year) were managed. TEF closed spontaneously in four patients, whereas in 5 patients the TEF closed after combined endoscopic procedure. Three patients required repeat endoscopic procedures. Follow-up ranged between 7 months to 10 years (mean 4.2 years).

Conclusions

Active observation and repeat combined endoscopic procedures are safe alternatives to open surgical repair of acquired and recurrent TEF.

Level of evidence

Level IV study.

Section snippets

Patients and methods

  • 1.

    Nine children, age 3 month to 3 years (mean 1.5 years) were referred to the pediatric surgery Service at The Aga Khan University Hospital, Karachi, Pakistan between 2003 and 2015. After approval from Ethical Review Committee (ERC), medical records were reviewed for patient demographics, symptoms and signs, medical and surgical history, location and size of TEF, management and outcome.

  • 2.

    Diagnosis of recurrent and acquired TEF was based on the presence of symptoms, contrast study of esophagus using

Results

The results are summarized in Table 1. Nine children (7 male and 2 female) with acquired (n = 6) and recurrent TEF following EA/TEF repair (n = 3) were managed. Acquired TEF developed 1 to 3 weeks after removal of esophageal FB—20 mm lithium battery-Maxell 2032 (3), sharp metallic nail (1) ballpoint pen (1) and accidental acid ingestion (1). Most of the patients presented with a history of choking on feedings and recurring respiratory infections. The site of the fistula was mid trachea (5), distal

Discussion

Recurrent TEF is reported in 3% to 20% of babies following repair of EA and TEF, despite refinements in the surgical technique and improvement in survival [1], [3], [4]. Acquired TEF is a rare entity in children, and is mostly caused by FBI (e.g., button battery), corrosive ingestion, iatrogenic injuries following tracheostomy as well as endotracheal intubation, and is rarely secondary to malignancy [5], [6], [7], [8]. Over the last three decades, ingestions of button batteries have increased

References (29)

Cited by (0)

View full text