Hua Kaiyun, Sun Jie, Sun Dayan, Zhao Yong, Huang Jinshi
Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Department of Neonatal Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
J Pediatr Surg. 2025 Aug 14;60(11):162566. doi: 10.1016/j.jpedsurg.2025.162566.
Esophageal-pulmonary fistula (EPF) is a rare complication after esophageal surgery, especially following esophageal atresia/tracheoesophageal fistula (EA/TEF) repair in neonates. Its clinical characteristics remain unclear, and the etiology is still under investigation. This study aims to describe the clinical features of EPF by comparing it with traditional recurrent TEF (rTEF) after EA repair.
We retrospectively analyzed children with rTEF after esophageal atresia repair from September 2017 to December 2023. Patients were grouped into EPF and TEF types for comparison. Statistical analysis was performed using SPSS 28.0. Categorical variables were compared using χ or Fisher's exact test, and continuous variables using t-test or Mann-Whitney U-test, with p < 0.05 considered significant.
Among 106 patients, 21 were diagnosed with EPF and 85 with TEF. Anastomotic leakage after initial EA repair occurred in 52.4 % of EPF patients, significantly higher than 28.2 % in the TEF group (P = 0.035). Anastomotic strictures were also more frequent in EPF patients (85.7 % vs. 57.6 %, P = 0.017). To further investigate the surgical outcomes, an analysis was undertaken on the 113 rTEF repair surgeries conducted across the cohort of 106 patients. Of these, 19 cases of EPF, 3 cases of esophagobronchial fistula (EBF), and 2 cases of combined EPF and TEF were classified as the EPF group (n = 24, 21.2 %), while the remaining 89 cases (78.8 %) comprised the TEF group. The comparative findings revealed that multiple fistula recurrences were significantly more common in the EPF group (50 % vs. 10.1 %, P < 0.001). However, no significant differences were found in overall surgical outcomes or postoperative recovery between the two groups.
EPF represents a rare and distinct subtype of rTEF following EA repair. Compared to TEF, EPF is associated with higher rates of anastomotic leakage, strictures, and multiple recurrences. These differences may aid in the identification and management of EPF among rTEF patients.
