title: Recurrent and acquired tracheoesophageal fistulae (TEF)-Minimally invasive management.
abstract: OBJECTIVE
  Recurrent and acquired fistulae are a serious complication of congenital esophageal atresia and tracheoesophageal fistula (TEF) repair and foreign body ingestion (FBI) (e.g., button battery). We report our experience with a minimally invasive approach to recurrent and acquired TEF.
  
  
  METHODS
  Medical records of patients referred for management of recurrent and acquired TEF between 2003 and 2015 were reviewed retrospectively. Patients underwent endoscopic procedures (de-epithelization of fistulous tract and fibrin tissue adhesive-TisseelR) under general anesthesia.
  
  
  RESULTS
  Nine children (7 male, 2 female) with age range 3months to 3years (mean 1.5year) were managed. TEF closed spontaneously in four patients, whereas in 5 patients the TEF closed after combined endoscopic procedure. Three patients required repeat endoscopic procedures. Follow-up ranged between 7months to 10years (mean 4.2years).
  
  
  CONCLUSIONS
  Active observation and repeat combined endoscopic procedures are safe alternatives to open surgical repair of acquired and recurrent TEF.
  
  
  METHODS
  Level IV study.
authors.affiliation: Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan. Electronic address: zafar.nazir@aku.edu.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Nazir
authors.affiliation: Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan.
authors.forename: Muhammad Arif Mateen
authors.initials: MAM
authors.lastname: Khan
authors.affiliation: Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan.
authors.forename: Javaria
authors.initials: J
authors.lastname: Qamar
mesh_terms: D002675:Child, Preschool; D004724:Endoscopy; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D005260:Female; D015718:Fibrin Tissue Adhesive; D005547:Foreign Bodies / Q000150:complications; D006801:Humans; D007223:Infant; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D055502:Secondary Prevention; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery*
chemical_list: D015718:Fibrin Tissue Adhesive
keywords: Acquired; Button battery; Endoscopic management; Foreign body ingestion; Recurrent; Tracheoesophageal fistula