Saniye Ekinci, Mehmet Emin Şenocak, İbrahim Karnak, Şule Yalçın, Tutku Soyer, Gül Şalcı, Arbay Özden Çiftçi, Gül Şalcı
Hacettepe University Medical Faculty Department of Pediatric Surgery, Ankara, Turkey


Introduction: Any tracheoesophageal fistula (TEF) diagnosed after primary repair of esophageal atresia (EA) and TEF may be recurrent, acquired or missed. This study is designed to define the challenges in diagnosis which lead a considerable delay in
Methods: Medical records of patients treated for TEF after primary repair of EA&TEF between 2006 and 2017 were evaluated retrospectively. Clinical findings, bronchoscopic and imaging studies to confirm fistula, surgical findings and results were analyzed. Fistulas were classified as recurrent (fistula occurring in the same location as the TEF repaired at primary operation), acquired (fistula occurring in a new pathway with a new location on either esophageal or tracheal site or both) and missed (proximal fistula missed when distal fistula was repaired).

Main Results: 6 female and 4 male patients who had persistent respiratory problems after primary repair of EA&TEF were diagnosed as TEF. Mean age of operation time was 3,2 (0,1-8) years. 12 thoracotomies and 3 cervical repair was performed (one patient had 3, and two patients had 2 thoracotomies, one patient had 1 thoracotomy and one cervical repair). Three patients had prior failed endoluminal treatments. Esophagography and bronchoscopy demonstrated the fistula in cases with missed fistula. But 2 patients with acquired and 6 patients with recurrent fistula had 4 bronchoscopies and 16 esophagographies failed to demonstrate the fistula. Eventually all patients had a successful repair of RTEF and doing well now. Closure of fistula was confirmed by esophagography and clinical evaluation in all patients. Mean follow-up time was 3,4 (0,5-10) years.

Conclusions: RTEFs remain a diagnostic and therapeutic challenge. Esophagography or bronchoscopic examination may fail to demonstrate recurrent or acquired tracheoesophageal fistula. Every attempt should be made to confirm possible TEF in patients with recurrent pneumonia after primary repair of EA&TEF.