Recurrent and acquired tracheoesophageal fistulae (TEF)-minimally invasive management.

Zafar Nazir, Aga Khan University
Muhammad Arif Mateen Khan, Aga Khan University
Javaria Qamar, Aga Khan University

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-Tisseel^R) under general anesthesia.

RESULTS: Nine children (7 male, 2 female) with age range 3months to 3years (mean 1.5year) 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 7months to 10years (mean 4.2years).

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.