Effect of Posterior Tracheopexy on Risk of Recurrence in Children after Recurrent Tracheo-Esophageal Fistula Repair

Kamran, Ali; Zendejas, Benjamin; Meisner, Jay; Choi, Sukgi S.; Julian, Carlos Munoz-San; Ngo, Peter; Manfredi, Michael A.; Yasuda, Jessica L.; Smithers, C. Jason; Hamilton, Thomas E.; Jennings, Russell W.

doi:10.1016/j.jamcollsurg.2021.01.011

Cited by 9 publications

(5 citation statements)

References 27 publications

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“…Closing the original TEF by ligation and prematurity could influence the occurrence of RTEF. 3,9,20 In our series, we could not show any statistically significant risk factor, and anastomotic leakage came closest of being statistically significant risk in RTEFe. The type of suture material used in closure of TEF may have significance, but in the present study, the issue could not be assessed.…”

Section: Discussioncontrasting

confidence: 62%

“…For repair of RTEF, several operative details such as intubation of RTEF tract with a catheter, complete separation of the esophagus from the trachea, rotation and suture fixation of suture lines of the esophagus and the trachea away from each other, and interposition of viable tissue such as pleura, pericardium, or muscle between the suture lines are performed. Other published methods that may reduce the risk of re-RTEF such as posterior tracheoplasty 20 and sliding tracheoplasty 21 were not used in the present series. Even in experienced hands, a considerable re-RTEF rate can be expected.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…In order to prevent the recurrence of tracheoesophageal fistulas, some authors recommend a tracheopexy to avoid this complication [24].…”

Section: Discussionmentioning

confidence: 99%

“…The source of airway-related symptoms can be attributed to injury of the recurrent laryngeal nerve, which is transient in most cases and reported to occur in 15% to 50% of patients [11,23]. Continuous recurrent laryngeal nerve monitoring has been proposed by some authors and may help identify the nerve during dissection [24]. As it is not uncommon for this problem to go unnoticed, some authors recommend performing postoperative routine vocal cord evaluation through laryngoscopy, aiming to identify unilateral or bilateral cord paralysis and establish a follow-up plan [11,25], although no established follow-up protocol exists.…”

Section: Discussionmentioning

confidence: 99%

Diagnosis and Management of Congenital H-Type Tracheoesophageal Fistula: Results of a National Survey

Morchio,

Ganarin,

Conforti

et al. 2024

Children

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Background: Congenital h-type tracheoesophageal fistula (H-TEF) without esophageal atresia (EA) represents about 4% of congenital esophageal anomalies. The diagnosis is challenging, and surgery is considered curative. The aim was to report a national survey on the diagnosis, management, and outcome of patients with congenital H-TEF. Methods: Following approval of the Italian Society of Pediatric Surgery, a survey was sent to all Pediatric Surgery Units to retrospectively collect H-TEF treated in the period 2010–2022. Descriptive analysis was performed, and results are given as prevalence, mean ± standard deviation (SD), or median and interquartile range (IQR). Results: The survey was sent to 65 units. Seventeen responded with one or more cases; 78 patients were diagnosed with H-TEF during the study period. Associated malformations were present in 43%, mostly cardiac (31%). The most frequent symptoms were cough (36%), bronchopneumonia (24%), and dysphagia (19%). H-TEF was detected by tracheobronchoscopy (90%), and/or upper GI (58%), and/or esophagoscopy (32%). The median age at diagnosis was 23 days (1 day–18 years). The most common approach was cervicotomy (76%), followed by thoracoscopy (14%) and thoracotomy (9%). The fistula underwent ligation and section of the fistula in 90% of the patients and clip closure and section in 9%. In one patient, the fistula was cauterized endoscopically. H-TEF preoperative cannulation was performed in 68% of cases, and a drain was placed in 26%. One month after surgery, 13% of the patients had mild persisting symptoms, mainly hypophonia. Recurrence occurred in 5%, and a second recurrence occurred in 1%. Conclusions: H-TEF prevalence was six cases/year, consistent with the expected rate of five cases/year in our country. The diagnosis was challenging, sometimes delayed, and, in most patients, required multiple examinations. Fistula ligation and section through cervicotomy were the most frequent treatment. Long-term outcomes are good, and recurrence is a rare event.

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“…Post‐pyloric feeds may further minimize reflux aspiration. Fistula closure may be performed through transoral endoscopic, thoracoscopic, or open surgical approaches (Table 2) (49,50). Pulmonary toilet and nutritional status should be optimized.…”

Section: Otolaryngology Complicationsmentioning

confidence: 99%

Recent Advances in the Genetic Pathogenesis, Diagnosis, and Management of Esophageal Atresia and Tracheoesophageal Fistula: A Review

O’Shea,

Schmoke,

Porigow

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Infants born with esophageal atresia and tracheoesophageal fistula (EA/TEF), a complex congenital malformation occurring in 1/2500-4000 live births, may suffer threats to their cardiac, respiratory, and digestive health in addition to anomalies that may exist in the genitourinary and musculoskeletal systems. Optimal care for these patients throughout their lives is best achieved through a coordinated, multidisciplinary approach that our healthcare system is not always well- equipped to provide. This review, though not exhaustive, highlights the components of care that pertain to initial surgical reconstruction and subsequent diagnosis and management of the complications that are most frequently encountered. Authors from among the many specialties involved in the care of these patients summarize the current best practice with attention to the most recent advances. Assessment and improvement of quality of life and transition to adult specialists as children grow to adulthood is also reviewed.

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Effect of Posterior Tracheopexy on Risk of Recurrence in Children after Recurrent Tracheo-Esophageal Fistula Repair

Cited by 9 publications

References 27 publications

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

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

Diagnosis and Management of Congenital H-Type Tracheoesophageal Fistula: Results of a National Survey

Recent Advances in the Genetic Pathogenesis, Diagnosis, and Management of Esophageal Atresia and Tracheoesophageal Fistula: A Review

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