P0979 - Posterior Tracheopexy Leads to Long-Term Zero Recurrence Rate after Surgical Treatment of Recurrent Tracheoesophageal Fistula

Background: A recurrent trachea-esophageal fistula (rTEF) occurs in approximately 5-10% of TEF repairs in children born with esophageal atresia (EA). The treatment of rTEF varies from endoscopic (e.g., glue, cauterization) to surgical approaches that aim to interpose tissue in between the trachea and the esophagus. However, most reports are limited by small numbers and short-term follow-up. Furthermore, re-recurrence remains a problem, making it difficult to elucidate the treatment of choice. The purpose of this study was to review the outcomes of our surgical approach featuring posterior tracheopexy.

Methods: Retrospective review of all EA patients with rTEF who were surgically treated at two referral centers (2012-2020). We completely mobilize the esophagus off of the trachea to reveal, divide, and repair TEF. Tracheal and esophageal suture lines are separated by suturing the posterior membranous trachea to the anterior longitudinal ligament of the spine (posterior tracheopexy), and the esophagus is further rotated into the right chest (rotational esophagoplasty). All patients undergo long-term surveillance with endoscopic and/or fluoroscopic contrast esophagograms during postoperative follow-up.

Results: 60 patients (93% EA type C) with rTEF, some with a history of prior failed endoscopic (18%) and/or surgical (25%) attempts, underwent surgical repair at a median age of 14 months (IQR, 7 - 24 months). With a median follow-up of 2 years (range, 1 month - 8 years), we have identified no recurrences. There has been one unrelated death.

Conclusion: This study represents the largest series of surgically treated recurrent TEFs. Based on this data with a zero recurrence rate and a median follow-up of 2 years, we propose that recurrent TEF repair by thoracotomy with complete mobilization of the esophagus and trachea, TEF division, and full separation of the suture lines via posterior tracheopexy and rotational esophagoplasty should be the treatment of choice for a recurrent TEF.