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Recurrent and acquired tracheoesophageal fistulae (TEF)—Minimally invasive management

  • Zafar Nazir
    Correspondence
    Corresponding author at: Section of Pediatric Surgery, Department of Surgery, The Aga Khan University, POB 3500, Stadium Rd., Karachi 74800, Pakistan. Tel.: +92 21 34863911, +92 300 2128878 (Cell); fax: +92 21 34862095.
    Affiliations
    Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan
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  • Muhammad Arif Mateen Khan
    Affiliations
    Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan
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  • Javaria Qamar
    Affiliations
    Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan
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      Abstract

      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 3 months to 3 years (mean 1.5 year) 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 7 months to 10 years (mean 4.2 years).

      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.

      Key words

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