Abstract
Aim of the studyComplex tracheo-oesophageal fistulae (TOF) are rare congenital or acquired conditions in children. We discuss here a multidisciplinary (MDT) approach adopted over the past 5 years.MethodsWe retrospectively collected data on all patients with recurrent or acquired TOF managed at a single institution. All cases were investigated with neck and thorax CT scan. Other investigations included flexible bronchoscopy and bronchogram (B&B), microlaryngobronchoscopy (MLB) and oesophagoscopy. All cases were subsequently discussed in an MDT meeting on an emergent basis if necessary.Main results14 patients were referred during this study period of which half had a congenital aetiology and the other half were acquired. The latter included button battery ingestions (5/7) and iatrogenic injuries during oesophageal atresia (OA) repair. Surgical repair was performed on cardiac bypass in 3/7 cases of recurrent congenital fistulae and all cases of acquired fistulae. Post-operatively, 9/14 (64%) patients suffered complications including anastomotic leak (1), bilateral vocal cord paresis (1), further recurrence (1), and mortality (1). Ten patients continue to receive surgical input encompassing tracheal/oesophageal stents and dilatations.ConclusionsMDT approach to complex cases is becoming increasingly common across all specialties and is important in making decisions in these difficult cases. The benefits include shared experience of rare cases and full access to multidisciplinary expertise.
Highlights
Complex tracheo-oesophageal fistulae (TOF) are rare conditions in children [1]. Most often these occur after repair of congenital oesophageal atresia (OA) with a distal TOF (C type)
The surgical repair of complex recurrent TOF or acquired lesions is challenging for a number of reasons
14 patients were referred during this study period of which half had a congenital aetiology (C-TOF) and the other half acquired (A-TOF)
Summary
Complex tracheo-oesophageal fistulae (TOF) are rare conditions in children [1]. Most often these occur after repair of congenital oesophageal atresia (OA) with a distal TOF (C type). Complex TOFs can be a result of oesophageal injury by ingestion of caustic fluids or button batteries [3, 4]. The surgical repair of complex recurrent TOF or acquired lesions is challenging for a number of reasons. The literature suggests that a prone oesophagogram whilst withdrawing an NG tube is the most sensitive investigation with the fewest false negatives [5]. The most sensitive test in our experience has been to perform
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