title: Long-term outcomes following H-type tracheoesophageal fistula repair in infants.
abstract: OBJECTIVE
  To evaluate outcomes following repair of H-type tracheoesophageal fistula (TEF).
  
  
  METHODS
  Retrospective chart review of infants with H-type TEF treated at our institution between 2000 and 2014. Patient demographics, surgical management, and postoperative function were evaluated.
  
  
  RESULTS
  Of the 268 patients with esophageal atresia/TEF treated at our center, 16 (6%) had an H-type TEF (10 males). Thirteen (81%) had associated anomalies. All patients were symptomatic: choking and sputtering were the most common presentation (n = 10, 63%). Diagnosis Age at diagnosis was 8 days (1 day-34 months). All patients were diagnosed based on a single esophagogram. Prior to surgery, 12 (75%) patients underwent bronchoscopy and 11 underwent cannulation of the TEF tract. Surgery All patients underwent open repair. One was started thoracoscopically but converted to open due to esophageal sero-muscular injury. Repair was achieved in all patients via a transcervical approach (right-sided incision in 15). One patient had an unsuccessful prior attempt at repair using tissue glue. Following TEF division, 11 patients had tissue interposition grafts placed (9 muscle, 2 fat). Postoperative course Eight (50%) patients had postoperative vocal cord paresis (6 right-sided, 2 bilateral). A patient developed recurrent TEF 78 days postoperatively that was subsequently repaired. Follow-up At 41 months (8-143), there were no mortalities, all patients with vocal cord paresis were asymptomatic despite the fact that only 3 of 8 (38%) regained function, and nine (56%) patients had gastro-esophageal reflux requiring treatment.
  
  
  CONCLUSIONS
  This large, single-center series demonstrates that H-type TEF can be diagnosed with esophagogram at an early age. Postoperative recurrent laryngeal nerve paresis and gastro-esophageal reflux disease are common following repair. Although most patients with vocal cord paresis eventually become asymptomatic, two-thirds do not regain vocal cord function. This reinforces the importance of routine examination of vocal cord movement following H-type TEF repair.
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
authors.forename: Augusto
authors.initials: A
authors.lastname: Zani
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
authors.forename: Luai
authors.initials: L
authors.lastname: Jamal
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cobellis
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
authors.forename: Justyna M
authors.initials: JM
authors.lastname: Wolinska
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
authors.forename: Samuel
authors.initials: S
authors.lastname: Fung
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
authors.forename: Evan J
authors.initials: EJ
authors.lastname: Propst
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
authors.forename: Priscilla P L
authors.initials: PP
authors.lastname: Chiu
authors.affiliation: Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada. agostino.pierro@sickkids.ca.
authors.forename: Agostino
authors.initials: A
authors.lastname: Pierro
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011184:Postoperative Period; D012189:Retrospective Studies; D013995:Time; D014138:Tracheoesophageal Fistula / Q000601:surgery*; D016896:Treatment Outcome
keywords: Esophageal atresia; Esophagogram; Isolated fistula; Laryngeal nerve paresis; N-type