The diagnosis and management of recurrent tracheoesophageal fistulas

J Pediatr Surg. 2010 Feb;45(2):337-40. doi: 10.1016/j.jpedsurg.2009.10.070.


Purpose: This review provides a blueprint to deal with the diagnosis and management of recurrent tracheoesophageal fistulas.

Methods: A retrospective review over 27 years found 26 recurrent tracheoesophageal fistulas. Descriptive statistical analyses were performed.

Results: In this cohort of 26 patients, 18 had a leak after their primary operation; and 22 had respiratory symptoms leading to the discovery of the recurrent fistula. The diagnosis was made by contrast study in 24. The repairs entailed placing a catheter through the fistula; separating the trachea and esophagus using sharp dissection; and placing tissue, preferably pericardium, between the suture lines. Postoperative complications included 7 anastamotic leaks, 4 strictures, and 3 recurrent fistulas. Long-term follow-up (median of 84 months) showed that 21 took all of their nutrition by mouth, 3 were tube fed, and 2 required a combination. Of the 23 patients with growth chart data, 16 fell in the first quartile of the growth chart, whereas none fell between the 75th and 100th percentile.

Conclusion: This series, the largest to date, describes characteristics of recurrent tracheoesophageal fistulas, including techniques to make the diagnosis and provide a secure closure of the fistula, and the long-term outcomes of these patients.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Anastomosis, Surgical / methods
  • Child
  • Child, Preschool
  • Esophageal Atresia / diagnosis
  • Esophageal Atresia / surgery
  • Esophageal Stenosis / diagnosis
  • Esophageal Stenosis / surgery
  • Esophagus / surgery
  • Female
  • Gastrostomy / methods
  • Humans
  • Infant
  • Infant, Newborn
  • Infant, Premature
  • Ligation / methods
  • Longitudinal Studies
  • Male
  • Outcome Assessment, Health Care
  • Postoperative Complications / diagnosis
  • Postoperative Complications / surgery
  • Recurrence
  • Reoperation / methods
  • Trachea / surgery
  • Tracheoesophageal Fistula / diagnosis*
  • Tracheoesophageal Fistula / surgery*
  • Treatment Outcome