Closure of Chronic Tracheoesophageal Fistula in Pediatrics Using Endoscopic Suturing.

Abstract

Tracheoesophageal fistula repair, especially in pediatric cases, presents challenges with traditional thoracotomy due to significant morbidity and recurrence rates. We introduce a novel technique- transglottic endoscopic suturing- for TEF repair in infants and young children. The method combines CO₂ laser de-epithelialization and suturing with a modified Prolene suture. Demonstrated in three cases of failed thoracotomy repairs, the procedure shows promising outcomes, with improvements in pulmonary function, oral feeding, and symptom resolution. Postoperative monitoring includes repeat bronchoscopy and esophagram, with Prolene suture removal in a follow-up procedure. Comparisons with traditional approaches highlight potential benefits, such as reduced morbidity, and complications. Although we acknowledge the small sample size as limitation, this technique shows promise in enhancing endoscopic TEF repair success rates. It provides an alternative for challenging cases, where repeated thoracotomies present significant morbidity. This approach has the potential for improving clinical outcomes with reduced morbidity in pediatric TEF patients.