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• W2000731548 abstract "Twenty-three pediatric patients had recurrent tracheoesophageal fistulas during the 17-year period from 1965 to 1982 after 250 repairs of esophageal atresia and TEF. There were 13 males and 10 females. Four babies had their newborn repair at other hospitals. Sixteen atresias had end-to-end repairs (none under tension) while there were seven Duhamel repairs (six under tension). There were 9 postoperative leaks and 10 strictures; 8 babies had neither. The recurrent fistulas were diagnosed from 7 days to 9 years after newborn operation and more than 50% within two months. All but three had some coughing, choking, gagging, cyanosis, apnes, dying spells, wheezing, and recurrent chest infection. Each fistula was diagnosed by barium swallow, although in four patients as many as six x-rays were needed before it was identified. Not one bronchoscopy in seven infants was diagnostic. All fistulas but one were repaired. No fistula closed spontaneously. They were repaired between 1 day and 14 months after diagnosis, most within 7 months. Recovery in the majority of cases was uneventful. However, 5 of the 22 repairs had a second recurrent TEF presenting in similar fashion between 2 weeks and 2 years; all but one within 11 months. All were repaired within 9 months of discovery. The DuHamel anastomosis was more prone to recurrent fistulization than the more common end-to-end type. More of our own patients had their original anastomosis done without any tension. Under these circumstances the esophageal anastomosis is in close proximity to the tracheal closure and a leak or local abscess could easily result in a reconnection between the esophagus and trachea. Any TEF baby who has signs and symptoms related to feeding and/or chest infections must be considered to have a recurrent TEF and a persistent and diligent search should be made for it. Twenty-three pediatric patients had recurrent tracheoesophageal fistulas during the 17-year period from 1965 to 1982 after 250 repairs of esophageal atresia and TEF. There were 13 males and 10 females. Four babies had their newborn repair at other hospitals. Sixteen atresias had end-to-end repairs (none under tension) while there were seven Duhamel repairs (six under tension). There were 9 postoperative leaks and 10 strictures; 8 babies had neither. The recurrent fistulas were diagnosed from 7 days to 9 years after newborn operation and more than 50% within two months. All but three had some coughing, choking, gagging, cyanosis, apnes, dying spells, wheezing, and recurrent chest infection. Each fistula was diagnosed by barium swallow, although in four patients as many as six x-rays were needed before it was identified. Not one bronchoscopy in seven infants was diagnostic. All fistulas but one were repaired. No fistula closed spontaneously. They were repaired between 1 day and 14 months after diagnosis, most within 7 months. Recovery in the majority of cases was uneventful. However, 5 of the 22 repairs had a second recurrent TEF presenting in similar fashion between 2 weeks and 2 years; all but one within 11 months. All were repaired within 9 months of discovery. The DuHamel anastomosis was more prone to recurrent fistulization than the more common end-to-end type. More of our own patients had their original anastomosis done without any tension. Under these circumstances the esophageal anastomosis is in close proximity to the tracheal closure and a leak or local abscess could easily result in a reconnection between the esophagus and trachea. Any TEF baby who has signs and symptoms related to feeding and/or chest infections must be considered to have a recurrent TEF and a persistent and diligent search should be made for it." @default.
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• W2000731548 date "1983-08-01" @default.
• W2000731548 modified "2023-09-27" @default.
• W2000731548 title "Recurrent tracheoesophageal fistulas seventeen-year review" @default.
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• W2000731548 doi "https://doi.org/10.1016/s0022-3468(83)80196-1" @default.
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