Congenital tracheoesophageal fistula without esophageal atresia

The authors report a series of eight cases of isolated tracheoesophageal fi stula without esophageal atresia (or an H type fistula), treated in three p ediatric ENT departments. This is a rare malformation whose diagnosis requi res investigation for associated anomalies. The clinical signs are mainly r espiratory but also digestive and the symptomatology can be severe. The dia gnosis can be made with a barium swallow combined with cineradiography, but a tracheoesophageal endoscopy remains the investigation of choice. The tre atment is surgical. In most cases, the fistula is accessible by a right or left cervicotomy, depending on the surgeon's practice, with a much lower po stoperative morbidity as compared to a thoracotomy. The postoperative manag ement was straightforward in most of our cases. We discuss the role of gast ro-esophageal reflux with respect to postoperative morbidity as well as sys tematic treatment for reflux peri-operatively. The pros and cons of the var ious surgical approaches are also discussed. (C) 1999 Elsevier Science Irel and Ltd. All rights reserved.