Congenital H-type Tracheo-oesophageal Fistula: An Institutional Review of a 10-year Period

BACKGROUND: Congenital H-type tracheo-oesophageal fistula (H-TOF ) accounts for 4%–5% of all congenital tracheo-oesophageal malformations. We present our experience in managing 18 cases with congenital H-TOF at a tertiary institute over a 10-year period. METHODS: Records of all patients with congenital H-TOF managed from January 2009 to December 2018 in the Department of Paediatric Surgery at a tertiary institute were retrospectively analysed based on the age at presentation, gender, antenatal ultrasonography findings; birth history; details of previous hospitalisations, previous treatment details, presenting symptoms and associated anomalies; time to diagnosis; radiological investigations performed, bronchoscopy findings, intraoperative details, complications and postoperative follow-up. RESULTS: Totally 18 patients with congenital H-TOF were managed over a 10-year period. There were 12 females and six males. Six patients had associated anomalies. There was wide variation in age at the start of symptoms (3 days–4 years) and presentation/referral to us (15 days–12 years). Four patients were diagnosed to have H-TOF at first admission. The most common presenting symptom was recurrent pneumonias (n=18). Bronchoscopy was done in all patients, and fistula was diagnosed and cannulated before surgery. The fistula was present at C8–T1 in 14 patients. The median age at surgery was 12 months. In 17 patients, the fistula was repaired by the cervical approach. There were two deaths, and 16 patients are doing well on median follow-up of 8 years. CONCLUSION: Congenital H-TOF should be considered in differential diagnosis while managing patients with recurrent lower respiratory tract infection and ‘coughing and choking episodes’; early diagnosis and management of the associated H-TOF is important for improved survival and outcome.