Infants with repaired esophageal atresia and distal tracheoesophageal fistula with severe respiratory distress: is it tracheomalacia, reflux, or both?

Aim of Study: Infants with repaired esophageal atresia and distal tracheoesophageal fistula (EA/TEF) are at risk for severe respiratory distress, which is related to tracheomalacia (TM), gastroesophageal reflux, or both. This usually mandates an operation for TM and/or a fundoplication procedure (FP). Methods: We retrospectively performed a 26-year review of 288 patients with repaired EA/TEF. Research Ethic Board approval was obtained. Results: Postoperatively, 22 (7.6%) infants with EA/TEF developed severe respiratory distress. Thirteen infants had an initial TM procedure and symptoms improved in 7 (54%). The 6 (46%) remaining patients with ongoing respiratory symptoms required an FP. Nine infants had an initial FP and the symptoms improved in 6 (67%). The remaining 3 (33%) patients with ongoing respiratory symptoms required a TM procedure. All patients improved with the second procedure. Several clinical parameters were assessed among the 4 patient groups (FP only, FP followed by TM procedure, TM procedure only, and TM procedure followed by FP); there were no significant differences noted. Conclusions: Whereas 54% to 67% of infants improved with a TM procedure or FP, 33% to 46% required both surgical procedures. No clinical parameters were identified that could predict which procedure should be performed first. (c) 2005 Elsevier Inc. All rights reserved.