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  Global Journal of Surgery. Volume 2, Issue 4 (2011) pp. 162-166
  Research Article
H-type tracheoesophageal fistula
  Ahmed H. al-Salem *, Akhter Nawaz  
The Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Saudi Arbia The Division of Pediatric Surgery, Al-Ain Hospital, Abudhabi, United Arab Emirates
  Objectives: To review the presentation, diagnostic evaluation, associated anomalies, surgical management, and postoperative complications of patients with H-type tracheoesophageal fistula (TEF). Methods: A retrospective review of patients with H-type TEF at our hospitals was done. Results: Among 135 patients treated for esophageal atresia (EA) with or without TEF, five (3.7%) with an H-type TEF were identified. All were females except one. Three of them were premature with a mean gestation of 32.7 weeks (range 31 weeks – 35 weeks). Their birth weight ranged from 1.35 kg to 2.95 (mean 2.35 kg). There were no other associated anomalies but two of them had associated anorectal agenesis. The age at diagnosis ranged from 5 days to 8 months (mean 78 days). All of them suffered from respiratory symptoms in the form of recurrent chest infection and cyanosis as well as chocking at the time of feedings. In all, the diagnosis was made with an esophagogram. One required two studies while another required three studies to confirm the diagnosis. All were successfully repaired via a right cervical approach. One of them developed a recurrent fistula because the fistula was ligated but not divided and two of them developed recurrent laryngeal nerve palsy which recovered spontaneously. Conclusions: To obviate delay in diagnosis, a high index of suspicion for an H-type TEF should be maintained in infants and children who present with choking and coughing during feeds, recurrent chest infection with or without abdominal distension. Repeat esophagograms may be required to establish the diagnosis. The transcervical approach is adequate to treat the majority of H-type TEF cases and the fistula should be divided after being ligated on both sides. To avoid airway obstruction in the postoperative period, attention should be paid to the recurrent laryngeal nerve at the time of surgery.
  Esophageal atresia and tracheoesophageal fistula; H-type tracheoesophageal fistula  

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