What are the complications of tracheoesophageal fistula (TEF)?

Updated: Nov 07, 2018
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Congenital and acquired TEFs are associated with multiple complications, including recurrent pneumonia, acute lung injury, acute respiratory distress syndrome, lung abscess, poor nutrition, bronchiectasis from recurrent aspiration, respiratory failure, and death.

In patients with esophageal atresia and a TEF, abnormal esophageal motility is always present because of abnormal development and innervation of esophagus. Long-term follow-up studies have reported complications of esophagitis, Barrett esophagus, and hiatal hernia.

The major postoperative complications are tracheal stenosis and recurrent fistula. Tracheal stenosis occurs in patients who have extensive injury to the posterior tracheal wall. Surgical repair of tracheal stenosis may be performed at a later date. Recurrent fistulas develop in patients who require continued postoperative intubation. This generally occurs from breakdown of the repair, and the risk of infection spreading into the soft tissue planes, neck, and mediastinum is high. Recurrent TEF in adults may also be a late complication of childhood surgical repair. [11]

Gastroesophageal reflux disease may later occur in half of patients who had repair for esophageal atresia and TEFs during the neonatal period. Treatment for reflux is antisecretory therapy. Rare complications of reflux are Barrett esophagus and esophageal carcinoma.

In children operated for esophageal atresia (EA) and/or TEFs, follow-up deglutitive and respiratory symptoms may occur and should be evaluated with videofluoroscopy. [12]

Vocal cord paresis/paralysis may occur more often in patients treated for esophageal atresia (EA) with and without fistula with thoracoscopic repair compared with open repair. [13] This may be due to thoracoscopic dissection of the esophagus high into the thoracic inlet. [13]

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