Congenital H-type tracheoesophageal fistula: A multicenter review of outcomes in a rare disease.
Objective: To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications.
Background: H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications.
Methods: A multicenter retrospective review of all H-type TEF patients treated at 14 tertiary children's hospital from 2002-2012 was performed. Data were systematically collected concerning associated anomalies, operative techniques, hospital course, and short and long-term outcomes. Descriptive analyses were performed.
Results: We identified 102 patients (median 9.5 per center, range 1-16) with H-type TEF. The overall survival was 97%. Most patients were repaired via the cervical approach (96%). The in-hospital complication rate, excluding vocal cord issues, was 16%; this included an 8% post-operative leak rate. Twenty-two percent failed initial extubation after repair. A total of 22% of the entire group had vocal cord abnormalities (paralysis or paresis) on laryngoscopy that were likely because of recurrent laryngeal nerve injury. Nine percent required a tracheostomy. Only 3% had a recurrent fistula, all of which were treated with reoperation.
Conclusions: There is a high rate of recurrent laryngeal nerve injury after H-type TEF repair. This underscores the need for meticulous surgical technique at the initial repair and suggests that early vocal cord evaluation should be performed for any post-operative respiratory difficulty. Routine evaluation of vocal cord function after H-type TEF repair should be considered.
Journal of pediatric surgery
Child, Preschool; Esophagoplasty; Female; Humans; Incidence; Infant; Infant, Newborn; Laryngoscopy; Male; Postoperative Complications; Rare Diseases; Recurrence; Recurrent Laryngeal Nerve Injuries; Reoperation; Retrospective Studies; Tracheoesophageal Fistula; Tracheostomy
TEF; Congenital esophageal anomaly; Neonatal; Pediatric; Recurrent laryngeal nerve injury; Tracheoesophageal fistula
Fallon SC, Langer JC, St Peter SD, et al. Congenital H-type tracheoesophageal fistula: A multicenter review of outcomes in a rare disease. J Pediatr Surg. 2017;52(11):1711-1714. doi:10.1016/j.jpedsurg.2017.05.002