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StayCurrentMD
Update Course Rewind 2025: The Recurrent TEF Problem
With Dr. Douglas von Allmen · hosted by Dr. Jill Knepprath
Chapter 2 of 4 · Case-Based Learning
Case presentation
Case Presentation: 7-Year-Old with Recurrent TEF
Cued at 1:06 · press play
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
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What the experts said
A 7-year-old patient with history of TEF-EA repair presented with chronic cough and food impaction.
The patient was referred for esophageal diverticulum and airway evaluation was performed.
Esophagoscopy showed a ledge formation at the esophageal anastomosis with a dilated upper pouch.
Second fistulas or H-type fistulas can be very difficult to manage endoscopically.
The transtracheal technique involves performing a distal tracheotomy, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula and working through it to divide the esophageal layers.
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.
Recurrent tracheoesophageal fistulas can develop years after initial TEF repair.
Esophageal dilations were performed without improvement.
Bronchoscopy revealed granulation tissue along the back wall of the airway.
The recurrent laryngeal nerve is at risk of damage during repair of recurrent TEFs.
A transtracheal approach provides better surgical exposure and reduces the risk of recurrent laryngeal nerve injury.
The transtracheal approach helps minimize injury to the recurrent laryngeal nerve.