Abstract
Objective The aim of this study was to assess incidence, risk factors, and outcomes of distal
recurrent tracheoesophageal fistula (RTEF) after repair of esophageal atresia (EA).
Methods Ethical consent was obtained. Data collection was done by review of hospital records
of 286 patients (268 in-house and 18 referred) who underwent repair of type C or D
EA from 1980 to 2021. Spitz class, long-gap (tracheoesophageal fistula at carina),
fundoplication, leakage, and stricture were assessed as RTEF risk factors. Outcome
measures were long-term closure of RTEF, retainment of native esophagus, and survival.
Results RTEF occurred in 23 patients (19 in-house) with type C (n = 22) or type D (n = 1) EA with median 4.4 (interquartile range [IQR]: 1.7–13) months after repair.
Five patients had late RTEF 3.5 to 16 years after repair. Nineteen (7.3%) in-house
patients developed RTEF. Presenting symptoms, age at diagnosis, and presence of anastomotic
stricture (AS) are listed. No statistically significant risk factors were found, risk
ratio of 0.5 to 2.7 (IQR: 0.1–8.7), p-value of 0.25 to 0.75. Detached closure clip and esophageal foreign body contributed
to RTEF in two patients. Sixteen patients underwent rethoracotomy for closure of RTEF,
5 (22%) with AS eventually underwent esophageal reconstruction after a period with
cervical esophagostomy. Two patients with late-manifested RTEFs underwent closure
with laser cauterization. In 22 patients, treatment of RTEF succeeded, whereas 1 (4%)
premature patient died of instant re-RTEF.
Conclusion RTEF had an incidence of 7% with diverse patterns of manifestation and predicting
factors. Closure rate and patient survival were excellent, but RTEF with AS predicted
loss of native esophagus.
Keywords
esophageal atresia - recurrent - fistula - esophageal repair
