title: [Multi-disciplinary hybrid therapy for tracheoesophageal fistula in children: analysis of 4 cases].
abstract: OBJECTIVE
  To explore an innovative technique that is aided by multi-disciplinary hybrid approach in identification and treatment of tracheoesophageal fistula (TEF) in children intraoperatively.
  
  
  METHODS
  From April 2008 to October 2011, 4 patients with isolated TEF were presented with 2 H-type fistulas and 2 recurrent TEF. For all the four cases, with the cooperation of the gastroenterologists, respiratory physician and surgeon, methylene blue was first injected into the trachea for detecting the dye in the esophagus by the gastroscopy. Bronchoscopy was performed where the fistula tract was shown by the methylene blue and a guide wire was passed through the fistula. The patients underwent rigid gastroscopy and the guide wire was identified and brought out through the mouth by biopsy pliers. This created a wire loop through the fistula. X-ray was then used to identify the level of the fistula. According to the level of the fistula it was determined whether surgical incision and approach should be used. The fistula was then repaired successfully by surgery.
  
  
  RESULTS
  In the 4 patients, with the aid of gastroscopy and bronchoscopy, identification of the fistula intraoperatively was then facilitated by traction on the loop. The fistula was identified and repaired. There were no fistula recurrences.
  
  
  CONCLUSIONS
  Multi-disciplinary hybrid therapy for tracheoesophageal fistula in children is beneficial for the precise localization of the fistula. This new technique is an effective and definitive method in identification and treatment of TEF in children.
authors.affiliation: Department of Pediatrics, Shanghai Children's Medical Center, Shanghai, China.
authors.forename: Zhao-hui
authors.initials: ZH
authors.lastname: Deng
authors.forename: Zhi-long
authors.initials: ZL
authors.lastname: Yan
authors.forename: Yong
authors.initials: Y
authors.lastname: Yin
authors.forename: Lei
authors.initials: L
authors.lastname: Zhang
authors.forename: Bo
authors.initials: B
authors.lastname: Chu
authors.forename: Ya-zheng
authors.initials: YZ
authors.lastname: Xu
authors.forename: Bin
authors.initials: B
authors.lastname: Zhang
authors.forename: Li-rong
authors.initials: LR
authors.lastname: Jiang
mesh_terms: D001999:Bronchoscopy / Q000379:methods*; D002675:Child, Preschool; D005260:Female; D005773:Gastroscopy / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010348:Patient Care Team; D012189:Retrospective Studies; D013536:Suture Techniques; D014138:Tracheoesophageal Fistula / Q000175:diagnosis* / Q000601:surgery*; D016896:Treatment Outcome