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https://hdl.handle.net/2440/133094
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Type: | Journal article |
Title: | H-type congenital tracheoesophageal fistula: Insights from 70 years of The Royal Children's Hospital experience |
Author: | Taghavi, K. Tan Tanny, S.P. Hawley, A. Brooks, J.A. Hutson, J.M. Teague, W.J. King, S.K. Nightingale, M. |
Citation: | Journal of Pediatric Surgery, 2020; 56(4):686-691 |
Publisher: | Elsevier |
Issue Date: | 2020 |
ISSN: | 0022-3468 1531-5037 |
Statement of Responsibility: | Kiarash Taghavi, Sharman P Tan Tannya, Alisa Hawley, Jo-Anne Brooks, John M Hutson, Warwick J Teague |
Abstract: | BACKGROUND:The long-term outcomes of H-type tracheoesophageal fistula (TOF), an uncommon variant of esophageal atresia/tracheoesophageal fistula (OA/TOF), are rarely described in the literature. We reviewed our institutional experience of 70 years. METHODS:The Nate Myers Oesophageal Atresia Database was queried for patients with an H-type TOF (1948-2017). Data included presentation, diagnostic workup, surgical management, and outcomes. RESULTS:Of 1088 patients with OA/TOF, 56 (5.1%) had an H-type TOF. The most common presenting symptoms were cyanotic episodes (68%), choking with feeds (52%), and aspiration pneumonitis (46%). The majority (82%) were symptomatic in the first week of life. Coexisting congenital anomalies were present in 46%: cardiac (13/56, 23%), genitourinary (10/56, 18%), and vertebral/skeletal (9/56, 16%). Patients were consistently diagnosed with prone contrast tube esophagogram (77% sensitivity on the first study and 96% after a second study). The fistula was most commonly approached through a right cervical collar incision. Right vocal cord palsy occurred in 22%, with one case of bilateral palsies. Other complications included leak (5.6%), recurrence (9.3%), stricture (1.9%), and diverticulum (1.9%). Although there was a trend towards a lower recurrence rate when interposition material was used, this was not statistically significant (3.3% vs 16.7%, p = 0.16). Survival in operative cases was 98.2%, and when all diagnosed cases were considered was 89.3%. CONCLUSIONS:We have reported the largest single-center series of H-type TOF. Diagnosis is challenging, and surgical morbidity remains high. Despite this, long-term outcomes are favorable. LEVEL OF EVIDENCE:IV. |
Keywords: | Esophageal atresia H-type fistula Tracheoesophageal fistula |
Rights: | Crown Copyright © 2020 Published by Elsevier Inc. All rights reserved. |
DOI: | 10.1016/j.jpedsurg.2020.06.048 |
Grant ID: | http://purl.org/au-research/grants/nhmrc/1168142 |
Published version: | http://dx.doi.org/10.1016/j.jpedsurg.2020.06.048 |
Appears in Collections: | Medicine publications |
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