Open Cervical Surgery for Congential H-Type Tracheoesophageal Fistulae (TOF)

Quick, Mark; Vijayasekaran, Shyan

Open Cervical Surgery for Congential H-Type Tracheoesophageal Fistulae (TOF)

Open Education Resource

2025-03-03

Abstract

Oesophageal atresia (OA) with or without a tracheoesophageal fistula (TOF) has an incidence of 1 in 2500 – 4500 live births. Two distinct TOF classification systems are used, with the initial system by Vogt published in 1929, that was later modified by Gross in 1953 into five types of TOF (Figure 1). The most common TOF is Type C (86%) comprising of a proximal blind oesophageal pouch and distal TOF into the distal oesophagus (Figure 1). Type E, better known as an H-type (Figure 1) fistula without OA, has an incidence of 4-7% of all TOFs. H-type fistulae have occurs in 1 in 50,000 to 80,000 live births. Endoscopic procedures have been employed to obliterate TOFs and include using fibrin glue, electrocautery, or laser coagulation of the fistula tract. Surgery remains the standard treatment with low recurrence rates. An open cervical approach is recommended for TOFs located above the level of T2 which accounts for majority of H-type TOFs.