Tracheo-Oesophageal Fistula – beyond the neonatal period

14 Oct 2022 09:15 09:40

With the advancement of neonatal intensive care and paediatric anaesthesiology, the survival rate of neonates following trachea-oesophageal fistula repair has improved tremendously. However, esophageal and pulmonary morbidity persists in children and adolescents. Follow up of these patients through  multidisciplinary clinics are helpful to detect any long term complications early so it can be addressed. Even more useful would be to have standardized guidelines on surveillance of these survivors. Clinicians should also be aware that one or more comorbidities are associated in about 50% of children with trachea-oesophageal fistula.

The long term complications in these survivors may be due to the intrinsic structural anomaly of the oesophagus or trachea. They will manifest with dysphagia, gastro-oesophageal reflux, oesophageal dysmotility, late oesophageal strictures, tracheomalacia or vocal cord dysfunction. The most common respiratory morbidity is tracheomalacia. This occurs due to longer and more compliant membranous portion of the posterior wall of the trachea, leading to poor secretion clearance and recurrent pneumonia.  The lung parenchyma may suffer from secondary insult due to recurrent aspiration or recurrent infection. Secondarily, from a thoracotomy done for repair, chest wall deformities may also occur, leading to reduction in lung function.

Satisfactory outcome of children beyond the neonatal period can be fostered by coordination with the surgical, medical, radiological and nutritional team.