title: Simplified access for division of the low cervical/high thoracic H-type tracheoesophageal fistula.
abstract: H-type tracheoesophageal fistulas (H-TEF) often are located in the low cervical/high thoracic region where determination of the most appropriate surgical approach is difficult. When it can provide adequate exposure, a cervical incision is preferred because of the likelihood of decreased morbidity. A child with VACTERL association presented with recurrent respiratory problems. Esophagogram showed an H-TEF below the level of the clavicle. A vascular guide wire was placed through the H-TEF with the ends brought out through the mouth. Under fluoroscopic guidance, gentle traction was placed on the wire to bring the fistula into the neck for an easily accessible cervical exposure, thus eliminating the need for a thoracotomy.
authors.affiliation: Department of Surgery, Kaiser Permanente Medical Center, Los Angeles, CA 90029, USA.
authors.forename: B A
authors.initials: BA
authors.lastname: Ko
authors.forename: R
authors.initials: R
authors.lastname: Frederic
authors.forename: P A
authors.initials: PA
authors.lastname: DiTirro
authors.forename: P A
authors.initials: PA
authors.lastname: Glatleider
authors.forename: H
authors.initials: H
authors.lastname: Applebaum
mesh_terms: D000015:Abnormalities, Multiple / Q000175:diagnosis; D002574:Cervical Vertebrae; D004935:Esophageal Diseases / Q000175:diagnosis / Q000601:surgery; D004945:Esophagoscopy / Q000379:methods*; D005471:Fluoroscopy / Q000379:methods; D006344:Heart Septal Defects, Atrial / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013904:Thoracic Vertebrae; D014133:Tracheal Diseases / Q000175:diagnosis / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome