Recurrent tracheoesophageal fistula | rTEF | Type of repair | Results | n° = 540 | rTEF after esophageal atresia surgery | 0-18 years | 27 studies included | Surgical repair vs. Endotracheal repair | Surgery | Endotracheal | Final Success rate | 97.7% | 72.6% | Complications | 31.0% | 2.1% | Number of procedures | 1.0-1.2 | 1.3-3.8 | Higher efficacy | Less morbidity | Choice should be individualized based on each patient and the center's experience. | Netherlands | Systematic review + Meta-analysis | 2000-2024 | Hut JE, et al. Eur J Pediatr Surg. May 2026. DOI: 10.1055/a-2868-4226 | Research: Francisca Asenjo Peña | Design: Gabriela Campos V. | European Journal of Pediatric Surgery | Journal Hive
Recurrent Tracheoesophageal Fistula: A Systematic Review and Meta-Analysis on Surgical and Endotracheal Treatment
Infographic · Aug 2026 · 2 min read
In brief
In brief
Meta-analysis of 540 patients comparing surgical versus endotracheal treatment for recurrent tracheoesophageal fistula shows surgery achieves 92% first-attempt success but 31% complication rate, while endotracheal approaches have lower success (28%) but fewer severe complications. Findings suggest endotracheal repair may be considered first-line despite requiring more procedures.
- Surgical treatment achieves 92% first-attempt success for recurrent TEF but carries 31% complication rate including strictures and leaks.
- Endotracheal treatment has lower initial success (28%) but significantly fewer severe complications (2%) than surgical approaches.
- Multiple endotracheal procedures (mean 1.3-3.8) can achieve 73% cumulative success with minimal morbidity compared to surgery.
- Endotracheal repair may be considered first-line given its minimally invasive nature and lower complication severity despite lower success.
- Surgical revision after failed endotracheal treatment remains highly effective (98% success) as a definitive backup option.
Written by the GCMD Library team from the infographic.
Three-panel infographic with teal headers. Left panel shows anatomical diagram of rTEF with atresia labeled. Center panel displays surgical and endotracheal repair icons with illustrated technique comparisons. Right panel presents results table comparing success rates, complications, and procedure numbers between approaches, with purple and blue accent colors highlighting key metrics.
Julia E. Hut, Marit J.B. van Stigt, Abdulqader Alitani, Ellen M.B.P. Reuling, Robert J. Stokroos, Stefaan H.A.J. Tytgat, Johannes W. Verweij, Arnold J.N. Bittermann, Maud Y.A. Lindeboom
Recurrent tracheoesophageal fistula (rTEF) is a complication of esophageal atresia, with treatment posing a significant challenge. Surgical treatment (ST) can be performed through thoracotomy, thoracoscopy, or via endotracheal treatment (ET) with de-epithelialization and/or sealants. The optimal treatment option for rTEF, however, remains unclear.
Aim
This study systematically reviewed the outcomes of ST and ET for rTEF to determine which treatment approach yields the best outcome.
Methods
The study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Embase, and the Cochrane Library were comprehensively searched for studies published from 2000 to December 2024. Two reviewers independently screened and analyzed the relevant studies. Success and complication rates were pooled using a random-effects model for the meta-analysis. For additional outcomes, descriptive statistics were used.
Results
Twenty-seven studies (15 case series, 12 cohort studies), including 540 patients with rTEF, were eligible for inclusion in the systematic review. Meta-analysis showed a pooled success rate after the first procedure of 92.4% (95% CI: 87.8–95.4%) for ST and 27.7% (95% CI: 18.3–39.6%) for ET. After revisional procedures, the success rates increased to 97.7% (95% CI: 92.7–99.3%) for ST and 72.6% (95% CI: 59.5–82.6%) for ET. The mean number of procedures ranged from 1.0 to 1.2 for ST and from 1.3 to 3.8 for ET. The pooled complication rate for ST was 31.0% (95% CI: 5.7–77.1%). The pooled complication rate for ET was 2.1% (95% CI: 0.01–24.1%). The most reported complications for ST included anastomotic strictures and leakage, while postoperative respiratory tract infections were the primary complications for ET.
Conclusion
These findings demonstrate that although ST is highly effective and efficient, it is also associated with a high risk of severe complications. In contrast, ET demonstrates a lower success rate, but complications occur less frequently and are less severe. Despite the lower success rate, the minimally invasive techniques and reduced complication risk of endotracheal repair may support its consideration as a first-line treatment option.
The text in the image
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.