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Updated: Sep 19, 2026

An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
Published on: April 17, 2020
Recurrent and acquired tracheoesophageal fistulae (TEF)-Minimally invasive management
Zafar Nazir1, Muhammad Arif Mateen Khan1, Javaria Qamar1
1Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan.
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 3months to 3years (mean 1.5year) 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 7months to 10years (mean 4.2years).
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.
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