Management of H-type tracheoesophageal fistula in children: A report of 3 cases

Abstract

H-type tracheoesophageal fistula (TEF) is a relatively uncommon congenital anomaly that can be difficult to identify and sometimes, challenging to repair. It is the Gross E type of esphageal atresia (EA) and constitutes 4% of all EA cases. Three infants with TEF were treated between 2003 and 2012. The diagnostic workup, surgical technique, and postoperative course of patients who underwent repair of H-TEF were reviewed. Conventional esophagram demonstrated the fistula in 2 of the patients and a cineradiographic procedure was performed to outline the H-TEF in the last patient. In all 3 cases the location of the fistula was confirmed by tracheoscopy. The closure of the fistula was made by cervical route in 2 cases and by thoracotomy in the remainig patient with distal located fistula. A high index of suspicion for an H-TEF should be maintained in the presence of neonatal respiratory symptoms. Since H-TEFs are known to be complicated with lower respiratory tract infection, early referral of these patients to pediatric surgeons and accurate and timely surgical treatment should be realized.