Sara C Fallon1, Jacob C Langer2, Shawn D St Peter3, KuoJen Tsao4, Caroline M Kellagher5, Dave R Lal6, Jill S Whitehouse7, Diana L Diesen8, Michael D Rollins9, Elizabeth Pontarelli10, Marcus M Malek11, Corey W Iqbal12, Jeffrey S Upperman13, Charles M Leys14, Mark L Wulkan15, Sarah J Hill16, Martin L Blakely17, Timothy D Kane18, David E Wesson19. 1. Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St. Suite 1210, Houston, TX 77030, USA. Electronic address: scchildr@bcm.edu. 2. Hospital for Sick Children, Dept of Ped Surg, 555 University Ave, Rm 1526, Toronto, ON M5G 1X8, Canada. Electronic address: jacob.langer@sickkids.ca. 3. Children's Mercy Hospital, 2401 Gillham Road, Kansas City, MO 64108, USA. Electronic address: sspeter@cmh.edu. 4. The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Pediatric Surgery, 6431 Fannin Street MSB 5.256, Houston, TX 77030, USA. Electronic address: KuoJen.Tsao@uth.tmc.edu. 5. The University of Texas Health Science Center at Houston, McGovern Medical School, Department of Pediatric Surgery, 6431 Fannin Street MSB 5.256, Houston, TX 77030, USA. Electronic address: Caroline.M.Kellagher@uth.tmc.edu. 6. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, 999 North 92nd Street, Suite C320, Milwaukee, WI 53226, USA. Electronic address: DLal@chw.org. 7. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Children's Hospital of Wisconsin, 999 North 92nd Street, Suite C320, Milwaukee, WI 53226, USA. Electronic address: jillswhitehouse@yahoo.com. 8. UT Southwestern Medical Center, Children's Health Dallas, Dallas, TX, USA. Electronic address: dld5b@hotmail.com. 9. Division of Pediatric Surgery, University of Utah, Primary Children's Hospital, 100N. Mario Capecchi, Suite 3800, Salt Lake City, UT 84113-1103, USA. Electronic address: Michael.Rollins@imail2.org. 10. Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA. Electronic address: epontarelli@ucdavis.edu. 11. Division of Pediatric General and Thoracic Surgery, Children's Hospital of Pittsburgh of UPMC, Faculty Pavilion 7th Floor, 4401 Penn Avenue, Pittsburgh, PA 15224, USA. Electronic address: Marcus.Malek@chp.edu. 12. University of California San Francisco, Department of Pediatric Surgery, Gateway Medical Building, 1825 Fourth St., Fifth Floor, 5B,San Francisco, CA 94158, USA. Electronic address: cwiqbal@yahoo.com. 13. Children's Hospital Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA. Electronic address: jupperman@chla.usc.edu. 14. University of Wisconsin, H4/744 CSC, 600 Highland Ave, Madison, WI 53792, USA. Electronic address: leys@surgery.wisc.edu. 15. Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, 201 Dowman Drive, Atlanta, GA 30322, USA. Electronic address: mwulkan@emory.edu. 16. Children's Healthcare of Atlanta, 1405 Clifton Road, Atlanta, GA 30322, USA. Electronic address: shill9@emory.edu. 17. Vanderbilt Children's Hospital, 2200 Children's Way, Suite 7100, Nashville, TN 37232, USA. Electronic address: martin.blakely@Vanderbilt.edu. 18. Childrens National Health System, 111 Michigan Avenue NW, Washington, DC 20010-2970, USA. Electronic address: tkane@cnmc.org. 19. Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Texas Children's Hospital, 6701 Fannin St. Suite 1210, Houston, TX 77030, USA. Electronic address: davidw@bcm.edu.
Abstract
OBJECTIVE: To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications. BACKGROUND: H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications. METHODS: A multicenter retrospective review of all H-type TEF patients treated at 14 tertiary children's hospital from 2002-2012 was performed. Data were systematically collected concerning associated anomalies, operative techniques, hospital course, and short and long-term outcomes. Descriptive analyses were performed. RESULTS: We identified 102 patients (median 9.5 per center, range 1-16) with H-type TEF. The overall survival was 97%. Most patients were repaired via the cervical approach (96%). The in-hospital complication rate, excluding vocal cord issues, was 16%; this included an 8% post-operative leak rate. Twenty-two percent failed initial extubation after repair. A total of 22% of the entire group had vocal cord abnormalities (paralysis or paresis) on laryngoscopy that were likely because of recurrent laryngeal nerve injury. Nine percent required a tracheostomy. Only 3% had a recurrent fistula, all of which were treated with reoperation. CONCLUSIONS: There is a high rate of recurrent laryngeal nerve injury after H-type TEF repair. This underscores the need for meticulous surgical technique at the initial repair and suggests that early vocal cord evaluation should be performed for any post-operative respiratory difficulty. Routine evaluation of vocal cord function after H-type TEF repair should be considered. THE LEVEL OF EVIDENCE RATING: Level IV.
OBJECTIVE: To perform a multicenter review of outcomes in patients with H-type tracheoesophageal fistula (TEF) in order to better understand the incidence and causes of post-operative complications. BACKGROUND: H-type TEF without esophageal atresia (EA) is a rare anomaly with a fundamentally different management algorithm than the more common types of EA/TEF. Outcomes after surgical treatment of H-type TEF are largely unknown, but many authoritative textbooks describe a high incidence of respiratory complications. METHODS: A multicenter retrospective review of all H-type TEF patients treated at 14 tertiary children's hospital from 2002-2012 was performed. Data were systematically collected concerning associated anomalies, operative techniques, hospital course, and short and long-term outcomes. Descriptive analyses were performed. RESULTS: We identified 102 patients (median 9.5 per center, range 1-16) with H-type TEF. The overall survival was 97%. Most patients were repaired via the cervical approach (96%). The in-hospital complication rate, excluding vocal cord issues, was 16%; this included an 8% post-operative leak rate. Twenty-two percent failed initial extubation after repair. A total of 22% of the entire group had vocal cord abnormalities (paralysis or paresis) on laryngoscopy that were likely because of recurrent laryngeal nerve injury. Nine percent required a tracheostomy. Only 3% had a recurrent fistula, all of which were treated with reoperation. CONCLUSIONS: There is a high rate of recurrent laryngeal nerve injury after H-type TEF repair. This underscores the need for meticulous surgical technique at the initial repair and suggests that early vocal cord evaluation should be performed for any post-operative respiratory difficulty. Routine evaluation of vocal cord function after H-type TEF repair should be considered. THE LEVEL OF EVIDENCE RATING: Level IV.
Authors: Maya Stevens; Christopher J Mayerl; Laura Bond; Rebecca Z German; Julie M Barkmeier-Kraemer Journal: Int J Pediatr Otorhinolaryngol Date: 2020-11-24 Impact factor: 1.675