Background & aims
Recurrent tracheoesophageal fistula (rTEF) after esophageal atresia requires complex management across different specialties. This study reviews our experience and discusses a multidisciplinary (MDT) approach adopted in the past 4 years.
We reviewed the medical records of 100 patients with rTEF managed by an MDT approach (post-MDT group) from 2016 to 2019. These cases were compared to a historical group of 35 patients with rTEF from 2012 to 2015 (pre-MDT group).
Of the 135 patients with rTEF, 124 were referred from other hospitals. Preoperative examination found tracheomalacia in 23 patients, vocal fold immobility in 19 patients, and laryngomalacia in five patients. The incidence of postoperative anastomotic leak, anastomotic stricture, and repeat recurrences was 28.1%, 23.0%, and 8.9%, respectively. The overall mortality rate was 4.4%. No statistical difference in postoperative complications was noted between the two groups. The duration of stay in the pediatric intensive care unit (P = 0.038), the duration of intubation (P = 0.049), the postoperative hospital stay (P = 0.011), and the total length of hospital stay (P = 0.001) were significantly lower in the post-MDT group. Mid-term follow-up showed 23 patients had pathological gastroesophageal reflux. Five of them underwent fundoplication and recovered.
The MDT approach by fostering coordination of surgical, medical, radiological, and nutritional management is beneficial in the management of rTEF and leads to a satisfactory outcome .
Abbreviations:rTEF (recurrent tracheoesophageal fistula), EATEF (esophageal fistula with tracheoesophageal fistula), GER (gastroesophageal reflux), MDT (multidisciplinary), DOS in PICU (duration of stay in the pediatric intensive care unit), LOS (total length of hospital stay), NG (naso-gastric), NJ (naso-jejunal), POD (postoperative day), AS (anastomotic stenosis), AL (anastomotic leak), CI (confidence interval)
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Published online: January 07, 2021
Accepted: December 29, 2020
Received in revised form: December 5, 2020
Received: September 9, 2020
© 2021 Published by Elsevier Inc.