Surgical procedure helps prevent recurrence in children afte
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A tracheoesophageal fistula (TEF) is a congenital defect in which an abnormal connection forms between a child's esophagus and trachea. Even after surgical repair, TEFs recur in about 10 to 15 percent of infants and children. Posterior tracheopexy and rotational esophagoplasty are very effective in preventing re-recurrence.

A recurrent tracheoesophageal fistula can complicate esophageal atresia and tracheoesophageal fistula (TEF) repair in children. Therapeutic approaches and the rate of recurrence vary widely. Researchers aimed to review their experience with the treatment of recurrent TEF using posterior tracheopexy, focusing on operative risks and long-term outcomes.

Researchers conducted a retrospective review of patients with esophageal atresia TEF with recurrent TEF treated at 2 institutions. They approach recurrent TEFs surgically. Once the TEF is divided and repaired, the membranous trachea is sutured to the anterior longitudinal ligament of the spine (posterior tracheopexy) and the esophagus is rotated into the right chest (rotational esophagoplasty), separating the suture lines widely. To detect re-recurrence, patients undergo endoscopic surveillance during follow-up.

62 patients with a recurrent TEF were surgically treated (posterior tracheopexy/rotational esophagoplasty) at a median age of 14 months. All had significant respiratory symptoms.

--On referral, 24 had earlier failed endoscopic and/or surgical attempts at repair. Twenty-nine required a concomitant esophageal anastomotic stricturoplasty or stricture resection.

--Postoperative morbidity included 3 esophageal leaks and 1 transient vocal cord dysfunction.

--They have identified no recurrences, with a median follow-up of 2.5 years, and all symptoms have resolved.

Conclusively, the surgical treatment of recurrent TEFs that incorporates a posterior tracheopexy and rotational esophagoplasty is highly effective for preventing re-recurrence with low perioperative morbidity.

Journal of the American College of Surgeons
Source: https://doi.org/10.1016/j.jamcollsurg.2021.01.011
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