Infants with repaired esophageal atresia and distal tracheoesophageal fistula with severe respiratory distress: is it tracheomalacia, reflux, or both?
OBJECTIVE
Infants with repaired esophageal atresia and distal tracheoesophageal fistula (EA/TEF) are at risk for severe respiratory distress, which is related to tracheomalacia (TM), gastroesophageal reflux, or both. This usually mandates an operation for TM and/or a fundoplication procedure (FP).


METHODS
We retrospectively performed a 26-year review of 288 patients with repaired EA/TEF. Research Ethic Board approval was obtained.


RESULTS
Postoperatively, 22 (7.6%) infants with EA/TEF developed severe respiratory distress. Thirteen infants had an initial TM procedure and symptoms improved in 7 (54%). The 6 (46%) remaining patients with ongoing respiratory symptoms required an FP. Nine infants had an initial FP and the symptoms improved in 6 (67%). The remaining 3 (33%) patients with ongoing respiratory symptoms required a TM procedure. All patients improved with the second procedure. Several clinical parameters were assessed among the 4 patient groups (FP only, FP followed by TM procedure, TM procedure only, and TM procedure followed by FP); there were no significant differences noted.


CONCLUSIONS
Whereas 54% to 67% of infants improved with a TM procedure or FP, 33% to 46% required both surgical procedures. No clinical parameters were identified that could predict which procedure should be performed first.
Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.
Ahmed
A
Nasr
Sigmund H
SH
Ein
J Ted
JT
Gerstle
D000015:Abnormalities, Multiple / Q000601:surgery*; D002675:Child, Preschool; D015897:Comorbidity; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000209:etiology*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications; D012120:Respiration Disorders / Q000209:etiology*; D012189:Retrospective Studies; D014133:Tracheal Diseases / Q000209:etiology; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*