The diagnosis and treatment of esophageal fistula after primary operation of congenital esophageal atresia

Objective To evaluate the diagnosis and treatment of esophageal fistula (EF) after primary operation of congenital esophageal atresia. Methods A retrospective review was performed for 128 patients(71 boys, 57 girls) diagnosed as type Ⅲ congenital esophageal atresia from December 2003 to April 2017. One hundred and four patients accepted surgery in our hospital (35 open surgeries, 69 thoracoscopic surgeries), 24 patients accepted surgery in other hospitals. According to the severity, 20 patients with EF were divided into two groups: 1)Esophageal pleural fistula (mostly within one month, EPF); 2)Tracheoesophageal fistula(TEF). Two patients had EF after open surgery, 6 patients had EF after thoracoscopic surgery and 12 patients were diagnosed as EF after surgeries in other hospitals. Among them, 2 patients were EPF, 15 patients were TEF and 3 patients had both. The mean time of recurrence in 5 patients with EPF was 11 days(IQR: 7.5~20.5), and 4 patients with EPF didn’t receive any treatment, only 1 patient needed nasogastric tube because of repeated pneumonia, all these 5 patients achieved self-healing and the mean time was 16 days(IQR: 9.5~38.0). Among the 18 patients with TEF, 4 patients were treated with gastrostomy or nasogastric tube, 2 patients accepted gastrostomy combined with esophageal segmented stent system, then the fistula repaired. 12 patients didn’t receive any preoperative treatments during the period of recurrence. Results Sixteen patients with TEF were cured and received a follow-up period of 1~40.6 months, 2 patients lost follow-up because of second recurrence. Patients who received gastrostomy (4 patients) or nasogastric tube (2 patients) all presented repeated pneumonia or choking; however 2 of the 4 patients received gastrostomy didn’t present any clinical symptoms after they were treated with esophageal segmented stent system, and oral-feeding was permitted. Conclusions Most of the EPF achieve self-healing which only need observation, sewing and cutting fistula through open surgery is an effective method for patients with TEF. Esophageal segmented stent system is an important transitional method of radical operation. Key words: Esophageal atresia; Tracheoesophageal fistula; Stent