[Congenital tracheoesophageal fistulas without esophageal atresia]

Between 1961 and 1982 sixteen patients with tracheo-oesophageal fistulae without oesophageal atresia (H type fistula) were treated at Hôpital Ste-Justine and Centre Hospitalier de l'Université Laval. Nine patients were male and seven female, with a mean birth weight of 2.8 kg. Five were premature. All presented at first feeding with coughing, choking and cyanosis. Seven had abdominal distension and six had hypersalivation. Mean age at time of definitive diagnosis was 39.1 days. The diagnosis was confirmed radiologically in all patients, a mean of 1.69 cine-radiographic procedures per patient being required. Cervical region (C7 - T2) fistulas were present in 14 and thoracic in 2 patients. Twelve patients were operated via a cervical approach and four via a thoracic approach. A Fogarty catheter was in place in 2 fistulae pre-op. Two patients required gastrostomy. Refeeding was started 3 days post-operatively. One died and one had fistula recurrence. Fifteen patients survived. One survivor had multiple episodes of cardio-respiratory arrest. None had major swallowing difficulties. We consider it imperative that fistulae be visualized before surgical intervention. Catheterization of the fistula utilizing a Fogarty catheter should be attempted prior to surgery. It is dangerous to dissect a cervical fistula via a thoracotomy.