Postoperative complications and long-term outcomes of tracheoesophageal fistula repair

Congenital tracheoesophageal fistula (TEF) is part of the esophageal atresia complex and can be associated with multiple congenital anomalies. With advancements in anesthesiology and neonatal intensive care support, the survival rate of infants with TEF has surpassed 90% and at present, the rare cases of postoperative mortality are typically due to extremely low birth weight and/or to the presence of associated comorbidities, such as congenital heart defects. TEF morbidity is partly secondary to the surgical repair and partly intrinsic to the anatomical anomaly. Postoperative complications include anastomotic leak, stricture, and recurrent fistula. Moreover, some patients develop long-term outcomes that include gastroesophageal reflux (GER) and esophagitis, dysphagia, tracheomalacia, vocal cord disorders, and risk of esophageal malignancy. Many aspects of the management of these short- and long-term sequelae remain controversial and lack a standardized approach. Nonetheless, it is widely accepted that patients with TEF require a multidisciplinary treatment and long-term follow-up. The purpose of this review was to evaluate the recent literature on TEF postoperative complications and long-term outcomes, with focus on the incidence, medical and surgical treatment, and controversial aspect of TEF postoperative management. Understanding the long-term functional outcomes helps to re-evaluate the impact of the old classical approaches of treatment and to optimize the modern medical and surgical techniques and follow-up management.