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.
Nasr
Ahmed
A
Division of General Surgery, Hospital for Sick Children, Toronto, Ontario, M5G 1X8, Canada.
Ein
Sigmund H
SH
Gerstle
J Ted
JT
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*