Eur J Pediatr Surg 2014; 24(05): 365-375
DOI: 10.1055/s-0034-1370780
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Management of Recurrent Tracheoesophageal Fistulas: A Systematic Review

Olugbenga Aworanti
1   Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland
2   Department of Paediatric Surgery, Our Lady's Children's Hospital, Crumlin, Dublin, Ireland
,
Sami Awadalla
1   Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland
› Author Affiliations
Further Information

Publication History

03 October 2013

11 January 2014

Publication Date:
28 March 2014 (online)

Abstract

Introduction The management of a recurrent tracheoesophageal fistula (RTEF) includes either open surgery (OS) or an endoscopic treatment (ET); the ideal option is unclear. We aim to comparatively review all published treatment options, and outcomes, for managing RTEF.

Materials and Methods A literature search was performed using the keywords “recurrent tracheoesophageal fistula.” All English language articles describing the management of RTEF in children were reviewed. A synthesis of the relevant data is presented in a descriptive form due to the heterogeneity of the included articles.

Results A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS. Of the 57 ET patients, there was an 84% success rate compared with 93.5% of 108 OS patients; the failed ET cases were all successfully treated by OS. The refistulation rate after OS was 21% and an average of 1.1 (range 1–2) procedures were required. After ET, the refistulation rate was 63% and an average of 2.1 (range 1–6) treatments were required for success; these results were reported after a maximum follow-up of 9 years and 23 years for ET and OS, respectively. The major complications after OS were 17 (16%) leaks and 4 (3.7%) deaths, while for ET 3 (5%) suffered respiratory distress postoperatively and there was 1 (1.7%) death.

Conclusion OS for RTEF has a low morbidity and mortality, a higher success rate, and requires fewer treatments than an endoscopic repair. The ideal ET is undecided but it remains a viable alternative provided treatment failures are anticipated and prompt redo treatments initiated to prevent ongoing respiratory morbidity.

 
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