title: Management of recurrent tracheoesophageal fistulas: a systematic review.
abstract: BACKGROUND
  The management of a recurrent tracheoesophageal fistula (RTEF) includes either open surgery (OS) or an endoscopic treatment (ET); the ideal option is unclear. We aim to comparatively review all published treatment options, and outcomes, for managing RTEF.
  
  
  METHODS
  A literature search was performed using the keywords "recurrent tracheoesophageal fistula." All English language articles describing the management of RTEF in children were reviewed. A synthesis of the relevant data is presented in a descriptive form due to the heterogeneity of the included articles.
  
  
  RESULTS
  A total of 44 papers between 1955 and 2013 described 165 patients; 57 ET and 108 OS. Of the 57 ET patients, there was an 84% success rate compared with 93.5% of 108 OS patients; the failed ET cases were all successfully treated by OS. The refistulation rate after OS was 21% and an average of 1.1 (range 1-2) procedures were required. After ET, the refistulation rate was 63% and an average of 2.1 (range 1-6) treatments were required for success; these results were reported after a maximum follow-up of 9 years and 23 years for ET and OS, respectively. The major complications after OS were 17 (16%) leaks and 4 (3.7%) deaths, while for ET 3 (5%) suffered respiratory distress postoperatively and there was 1 (1.7%) death.
  
  
  CONCLUSIONS
  OS for RTEF has a low morbidity and mortality, a higher success rate, and requires fewer treatments than an endoscopic repair. The ideal ET is undecided but it remains a viable alternative provided treatment failures are anticipated and prompt redo treatments initiated to prevent ongoing respiratory morbidity.
authors.affiliation: Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland.
authors.forename: Olugbenga
authors.initials: O
authors.lastname: Aworanti
authors.affiliation: Department of Paediatric Surgery, Children's University Hospital, Dublin, Ireland.
authors.forename: Sami
authors.initials: S
authors.lastname: Awadalla
mesh_terms: D001999:Bronchoscopy; D004945:Esophagoscopy; D006801:Humans; D011183:Postoperative Complications; D012008:Recurrence; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome