Transtracheal approach for recurrent tracheoesophageal fistula repair

The seven-year-old patient had a history of TEF with prior repair and was presenting with chronic cough and food impaction.

The patient was referred for esophageal diverticulum and airway evaluation was performed.

Esophagoscopy showed the esophageal anastomosis with a ledge formation and dilated upper pouch.

Bronchoscopy revealed granulation tissue along the back wall of the airway.

Second fistulas or H-type fistulas can be very difficult to manage endoscopically.

Esophagram demonstrated mismatch and out-pouching at the anastomosis site.

The transtracheal technique involves performing a distal tracheotomy with ET tube placement, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula site.

The surgeon works through the tracheotomy to divide the layers of the esophagus.

Recurrent laryngeal nerve injury is underreported.

True recurrent laryngeal nerve paralysis leads to muscle atrophy over time, resulting in long-term voice problems and potential aspiration issues.