Congenital tracheoesophageal fistula without esophageal atresia.

Between Jan. 1, 1961 and Dec. 31, 1981, 16 infants (9 boys, 7 girls) with tracheoesophageal fistula without esophageal atresia (H-type fistula) were treated at the Hôpital Sainte-Justine and Centre Hospitalier de l'Université Laval. The mean birth weight was 2.8 kg. Five infants were premature. All presented at first feeding with coughing, choking and cyanosis. Seven had abdominal distension and six had hypersalivation. Mean age at the time of definitive diagnosis was 39.1 days. The diagnosis was confirmed radiologically in all infants, a mean of 1.69 roentgenographic procedures per patient being required. Cervicothoracic (C7 to T2) fistulas were present in 14 and thoracic fistulas in 2 infants. Twelve were operated upon through a cervical and 4 through a thoracic approach. A Fogarty catheter was placed in two fistulas preoperatively. Two patients required gastrostomy. Feeding was started again 3 days postoperatively. One infant died and one had a recurrent fistula. One survivor had 20 episodes of cardiorespiratory arrest. None had dysphagia. The authors consider it imperative that fistulas be visualized before any operative procedure is performed. Catheterization of the fistula with a Fogarty catheter should be attempted preoperatively. It is dangerous to dissect a cervical fistula through a thoracotomy.