title: [Recurrent tracheoesophageal fistula in type III esophageal atresia. Diagnosis and treatment are not easy].
abstract: Recurrent tracheoesophageal fistula (TEF) is possible after repair of congenital esophageal atresia. The frequency of recurrent TEF is observed in about 10% of the cases. Within a cohort of 67 children with type III esophageal atresia repaired between 1998 and 2009, we aimed to identify the number of children with recurrent TEF, the risk factors for this condition, and the treatment proposed. The sex ratio was 1.7. Surgery was performed between 4 and 36 hours of life. Five children (7.5%) had a recurrent TEF, usually during the first 3 months, revealed by respiratory symptoms related to feeding in some cases. We noted that recurrent TEF was more frequent with anastomotic leakage (P=0.09) or postsurgical pneumothorax (P<0.01). The diagnosis was made in four cases out of five by a methylene blue test performed during a tracheobronchial endoscopy. Surgical treatment was noted in four children, with three postsurgical secondary effects. One child was treated by endoscopy and an esophageal clip. With a median follow-up of 52 months, no recurrence was noted. The recurrence of TEF may be linked to postsurgical events. Diagnosis is not easy and treatment is not clearly codified. Endoscopic treatment may be an advantageous option to surgery, likely with less morbidity.
authors.affiliation: Unité de pneumologie pédiatrique, CHU Timone-Enfants, 13385 Marseille cedex 5, France.
authors.forename: C
authors.initials: C
authors.lastname: Lepeytre
authors.affiliation: Service de pédiatrie multidisciplinaire, CHU Timone-Enfants, 13385 Marseille cedex 5, France.
authors.forename: B
authors.initials: B
authors.lastname: Roquelaure
authors.affiliation: Service de chirurgie pédiatrique, CHU Timone-Enfants, 13385 Marseille cedex 5, France; Centre de compétence des atrésies de l'œsophage, CHU Timone-Enfants, 13385 Marseille cedex 5, France.
authors.forename: P
authors.initials: P
authors.lastname: de Lagausie
authors.affiliation: Centre de compétence des atrésies de l'œsophage, CHU Timone-Enfants, 13385 Marseille cedex 5, France; Service de chirurgie pédiatrique, hôpital Nord, 13915 Marseille cedex 20, France.
authors.forename: T
authors.initials: T
authors.lastname: Merrot
authors.affiliation: Unité de pneumologie pédiatrique, CHU Timone-Enfants, 13385 Marseille cedex 5, France; Centre de compétence des atrésies de l'œsophage, CHU Timone-Enfants, 13385 Marseille cedex 5, France. Electronic address: jean-christophe.dubus@ap-hm.fr.
authors.forename: J-C
authors.initials: JC
authors.lastname: Dubus
mesh_terms: D057868:Anastomotic Leak; D015331:Cohort Studies; D004724:Endoscopy; D004933:Esophageal Atresia / Q000145:classification / Q000150:complications* / Q000601:surgery; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011030:Pneumothorax / Q000150:complications; D011183:Postoperative Complications; D012008:Recurrence; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery*