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Eur J Pediatr Surg 2023; 33(01): 068-073
DOI: 10.1055/s-0042-1758154
Original Article

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

Antti Koivusalo
1   Section of Pediatric Surgery, New Children's Hospital, University of Helsinki, Helsinki, Finland
,
Annika Mutanen
1   Section of Pediatric Surgery, New Children's Hospital, University of Helsinki, Helsinki, Finland
,
Janne Suominen
1   Section of Pediatric Surgery, New Children's Hospital, University of Helsinki, Helsinki, Finland
,
Mikko Pakarinen
1   Section of Pediatric Surgery, New Children's Hospital, University of Helsinki, Helsinki, Finland
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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


Publication History

Received: 01 June 2022

Accepted: 06 September 2022

Article published online:
05 December 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
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