Diagnostic and management strategies for congenital H-type tracheoesophageal fistula: a systematic review

Sampat, Keerthika and Losty, Paul D ORCID: 0000-0003-0841-5879 (2021) Diagnostic and management strategies for congenital H-type tracheoesophageal fistula: a systematic review. PEDIATRIC SURGERY INTERNATIONAL, 37 (5). pp. 539-547.

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Official URL: http://dx.doi.org/10.1007/s00383-020-04853-3

Abstract

<h4>Background</h4>H type tracheoesophageal fistula (H-TEF) is a rare congenital anomaly. Management may be complicated by late diagnosis and variation(s) in the therapeutic strategy. A systematic review of published studies explores the utility of diagnostic studies, operations and postoperative complications.<h4>Methods</h4>Medline and PubMed database(s) were searched for ALL studies reporting H-TEF during 1997-2020. Using PRISMA methodology, manuscripts were screened for eligibility and reporting.<h4>Results</h4>Forty-seven eligible studies were analysed. Primary diagnosis varied widely with surgeons performing oesophagography and trachea-bronchoscopy. Preoperative localisation techniques included fluoroscopy, guidewire placement and catheterisation. A cervical approach (209 of 272 cases), as well as thoracotomy, thoracoscopy and endoscopic fistula ligation, were all described. Morbidity included fistula recurrence (1.7%), leak (2%), tracheomalacia (3.4%) and respiratory sequelae (1%). The major adverse complication in all studies was vocal cord palsy secondary to laryngeal nerve injury (18.5%) yet strikingly few centres routinely reported undertaking vocal cord screening pre or postoperatively.<h4>Conclusion</h4>This study shows that paediatric surgeons record low volume activity with H type tracheoesophageal fistula. Variation(s) in clinical practice are widely evident. Laryngeal nerve injury and its subsequent management warrant special consideration. Care pathways may offset attendant morbidity and define 'best practice.'

Item Type:	Article
Uncontrolled Keywords:	H type tracheoesophageal fistula, Congenital oesophageal anomaly, Clinical outcomes, Recurrent laryngeal nerve injury, Newborns, Paediatric
Depositing User:	Symplectic Admin
Date Deposited:	10 Feb 2021 12:03
Last Modified:	18 Jan 2023 23:00
DOI:	10.1007/s00383-020-04853-3
Open Access URL:	https://doi.org/10.1007/s00383-020-04853-3
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3115446