Abstract
Purpose: Recurrent tracheoesophageal fistula (RTEF) is an intractable complication in children, who receive treatment for esophageal atresia (EA) with tracheoesophageal fistula (TEF). We aimed to demonstrate the usefulness of biotissue patches in the treatment of RTEF.
Methods: Six patients presenting with RTEF after performed radical operation, underwent implantation by the biotissue patch between 2001 to 2011; these included 4 patients who received the operation for EA at our department and 2 patients who received the repeated operations for RTEF at other hospitals. The age at operation for the RTEF was between 4 months and 5 years 4 months.
Results: We performed the closing RTEF technique for six cases that used implantation of biotissue graft between the esophagus and trachea. Used biotissue grafts were pedunculate pleurae in 2 cases, pedunculate pericardia in 2 cases, a free pericardium in 1 case, a pedunculate omentum in 1 case, an isolated latae fascia and auricular cartilage in 1 case. In one patient, who underwent a previous open-heart surgery, RTEF was repeated. A small free pericardium graft was used unavoidably in the 2nd operation. The auricular cartilage was used for the tracheal side, and the free latae fascia was used for the esophageal side in the 3rd operation. There is no evidence of recurrence in any patients for 1 to 9 years in the follow-up.
Conclusion: In cases of intractable RTEF, the biotissue graft should be selected on the basis of the patient's medical history, surgical history, and degree of inflammation, and should be implanted as extensive as possible.
