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Recurrent tracheo-oesophageal fistula: experience with 24 patients
K E Ghandour1, L Spitz, R J Brereton
1Department of Paediatric Surgery, Hospital for Sick Children, London, UK.
Insights
Recurrent tracheo-oesophageal fistula occurs in 8% of infants after initial repair. Early diagnosis with imaging and prompt surgical intervention are crucial for managing this complication in neonates.
Area of Science:
- Pediatric Surgery
- Neonatal Care
- Congenital Anomalies
Background:
- Esophageal atresia and tracheo-oesophageal fistula are congenital conditions requiring surgical correction.
- Recurrence of the fistula after initial repair is a known complication.
Observation:
- Over 11 years, 275 infants with esophageal atresia and tracheo-oesophageal fistula were treated.
- 22 infants (8%) developed a recurrent fistula; 2 additional referred patients underwent secondary surgery.
- 24 patients with recurrent fistula underwent operative repair.
Findings:
- The study identified a recurrence rate of 8% in infants treated for esophageal atresia and tracheo-oesophageal fistula.
- Operative repair of recurrent fistula in 24 patients resulted in 3 deaths (12.5%) and 4 second recurrences (16.6%).
- Five patients required secondary esophageal replacement due to recurrent fistula.
Implications:
- Urgent investigation with cine-radiography and/or bronchoscopy is recommended for infants with respiratory symptoms post-repair.
- Timely surgical intervention for diagnosed recurrent fistulas is critical.
- The management of recurrent tracheo-oesophageal fistula presents significant challenges, including mortality and re-recurrence rates.
Abstract:
Over an 11 year period, 275 infants with oesophageal atresia and tracheo-oesophageal fistula were treated. Of these, 22 (8%) developed a recurrent fistula. An additional two patients with an established recurrent fistula were referred for secondary surgery. Infants who develop respiratory symptoms associated with feeding following repair of an oesophageal atresia should be investigated urgently with cine-radiography and/or bronchoscopy. Once the diagnosis of a recurrent fistula has been firmly established, operative repair should be undertaken. In our series of 24 patients, there were three deaths (12.5%), four patients developed a second recurrence (16.6%), while a secondary oesphageal replacement was carried out on five patients.