Comparison of Diagnostic Methods, Surgical Approaches and Outcome for Congenital H-Type Tracheoesophageal Fistula: A Systematic Review

Abstract

Background: The evidence for the effectiveness and safety of diagnostic and therapeutic interventions for congenital H-type tracheoesophageal fistula (H-TEF) is limited. We aimed to explore the diagnostic methods, surgical approaches, complications, and outcome in patients with H-TEF.

Methods: A literature search was conducted in EMBASE, PubMed, and Medline databases from January 2003 to December 2023, focusing on terms related to H-TEF, various surgical approaches, and surgical outcomes.

Results: A total of 24 studies were included in the qualitative analysis, and 6 studies were suitable for quantitative analysis, comprising 81 patients who underwent 84 surgical procedures. The primary diagnostic methods included contrast esophagography (76 cases), bronchoscopy (63 cases), esophagoscopy (23 cases), and CT (4 cases). Bronchoscopy had the highest diagnostic accuracy (100 %), whereas esophagography had a diagnostic rate of 86.4 %. The cervical approach was the most frequently used surgical technique (88 %), while the thoracic approach was associated with fewer complications. Postoperative complications included vocal cord paralysis (14 %), gastroesophageal reflux (17 %), and recurrence (4 %). Mortality occurred in 2.4 % of patients, both following cervical repair.

Conclusion: This systematic review emphasizes the challenges with the identification and treatment of congenital H-TEF. Bronchoscopy is the most accurate diagnostic tool. The cervical approach is more widely used but has a higher complication rate. Further research is necessary to determine the optimal surgical procedure and evaluate the potential role of interposition grafts in preventing recurrence.

Keywords: Congenital tracheoesophageal fistula; Gross type E fistula; H-type tracheoesophageal fistula; Isolated tracheoesophageal fistula; Systematic review.