Usefulness of large pleural flap for the treatment of children with recurrent tracheoesophageal fistula.
OBJECTIVE
Recurrent tracheoesophageal fistula (RTF) complicates 5-11% of cases of children treated at birth for esophageal atresia with inferior tracheoesophageal fistula (ITF), and it represents an important problem of respiratory morbility and mortality. Surgical correction of RTF is complex with high incidence of recurrence. The aim of this work is to demonstrate the usefulness of large vascularized pleural flap in the treatment of RTF and the prevention of recurrences.


METHODS
From 2000 to 2007, four children (3 males and 1 female) referred to our hospital for respiratory symptoms secondary to RTF. Diagnosis of RTF was made by bronchoscopy and esophagogram with contrast medium. Operative repair involved resection of the fistula, suture of trachea and esophagus followed by interposition of large vascularized pleural flap (PF).


RESULTS
There were no complications during surgical procedure and after 48 h, with easy respiratory weaning after 24 h. Hospital discharge ranged from 5 to 10 days. Long-term follow-up (range 18 months-5 years) demonstrated no evidence of recurrences.


CONCLUSIONS
Large vascularized PF to closure RTF is a highly effective and physiologic method for preventing second recurrences.
Briganti
Vito
V
UOC di Chirurgia Pediatrica, Azienda Ospedaliera S. Camillo-Forlanini, via Cicerone 60, Rome 00193, Italy. vito.briganti@fastwebnet.it
Mangia
Giovanni
G
Ialongo
Pasquale
P
Calisti
Alessandro
A
D002675:Child, Preschool; D004947:Esophagus / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D010994:Pleura / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D012008:Recurrence; D012086:Reoperation; D012121:Respiration, Artificial; D013524:Surgical Flaps; D014132:Trachea / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome