Outcome of Recurrent Tracheoesophageal Fistula Treatment After Esophageal Atresia Repair

Introduction
Recurrent Tracheoesophageal Fistula (rTEF) is a complication of Esophageal Atresia (EA) that can lead to severe respiratory symptoms. RTEF can be corrected via endotracheal treatment (ET) or surgical treatment (ST). The efficacy of these techniques varies in literature. This study presents the outcome of rTEF treatment after EA correction at the Wilhelmina Children's Hospital in Utrecht.
Methods
From 2000 until 2023, patients with EA (n = 251) underwent thoracoscopic EA correction by using the native esophagus at the Wilhelmina Children's Hospital in Utrecht. All EA patients who had developed rTEF (n = 19) were evaluated. Success rates, number of treatment attempts, and complication rates of ET and ST were collected in our EA database. Data was expressed as medians with interquartile ranges (IQR).
Results
In total, 19/251 (8 %) patients had developed an rTEF after EA correction. For 10/19 (53 %) patients, primary ET was performed, with a median number of 2 procedures per patient [range 1–3]. In 8/10 patients, ET failed, therefore, these eight patients underwent secondary ST. For 9/19 (47 %) patients, primary ST was performed, with a median number of 1 procedure per patient [range 1–3]. In all patients, primary ST was performed via thoracoscopy with a success rate (absence of recurrence after 1 procedure) of 78 % (7/9) and no conversions. The complication rate was 10 % for primary ET and 44 % for primary ST, and 75 % for secondary ST. All complications were classified as minor.
Conclusion
Thoracoscopic correction of rTEF has a high success rate. Similar to previous studies, the Utrecht success rate of ET for rTEF treatment is poor.