Tracheoesophageal Fistula
Everything in the library about tracheoesophageal fistula — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Fundamentals
1 item
Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery
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This video provides a clear, visual explanation of Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF), common congenital anomalies in pediatric surgery. Jill Knepprath, MD demonstrates normal anatomy and then breaks down the differ
video2:11 · Sep 2026
Surgical Management
6 items
Thoracoscopic Repair of Tracheo-esophageal Fistula Tricks: Pediatric Surgery...
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During the Pediatric Surgery Tricks of the Trade and Difficult Cases: Innovative Solutions to Common Problems Course in 2013, Dr. Atsuyuki Yamataka discusses preoperative gap assessment and thoracoscopic repair intracheoesophageal fistula w
video19:14 · Sep 2018
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
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Dr. Michael Rutter presents multiple case studies of patients with esophageal fistulas and repair approaches to each.
video108:11 · Jan 2019
Tracheoesophageal Fistula with Dr. Daniel von Allmen
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This podcast discusses the work up, operative management, and follow-up management of tracheoesophageal fistulas. Dr. Todd Ponsky is an associate professor of surgery and pediatrics and pediatric surgeon at Akron Children's Hospital. Dr. Av
podcast45:21 · Dec 2020
Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement
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Pediatric surgeons Dr. Daniel Von Allmen and Dr. Todd Ponsky from Cincinnati children's Hospital discussing the technique for treating long gap esophageal atresia. For additional info please visit: https://www.youtube.com/c/CincinnatiChildr
podcast10:56 · Jan 2022
QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video7:37 · Mar 2024
Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
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Marc Michalsky, MD, MBA, FACS, FAAP, FASMBS - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
Surgical Grand Rounds (October 29, 2025)
video66:48 · Oct 2025
Evidence & Research
3 items
Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course,Dr. Alexander Gibbons discusses the history of surgical repair oftracheoesophageal fistulas, with focus on the controversy of thoracoscopic versus open TEF repair.
video18:17 · Sep 2018
Case Based Journal Review: Esophageal Atresia in 2022
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Dr. José Campos is back, this time helping us review some of the latest literature on the diagnosis and management of Esophageal Atresia in children. In this podcast, we're reviewing a typical case with Dr. Todd Ponsky and incorporating lit
podcast17:55 · Aug 2022
Quick Literature Updates Episode 9
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We’re back with ninth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review four articles covering the most int
video · Jun 2023
Case-Based Learning
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Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula
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Dr. Todd Ponsky introduces the seminar covering complexities in the management of Tracheal Esophageal Fistula (TEF). Points of interest will include discussion around the "unsalvageable esophagus" and diagnosis of TEF. Dr. Michael Rutter, P
video120:59 · Nov 2018
In-Depth Reviews
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Esophageal Atresia
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Comprehensive discussion of esophageal atresia and esophageal fistulas by Robert Parry. Initial management, operative management, pre operative echocardiogram, chest tube, thoracoscopic versus open esophageal atresia,TEF repair, long gap es
video39:30 · Nov 2018
Long-Term Care
1 item
QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team
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In this special episode from the QUAD Conference hosted by Cincinnati Children’s, Lizzy Lee takes us inside one of the world’s largest and most advanced multidisciplinary programs for children with complex airway and digestive conditions: t
video10:19 · Apr 2025
Summaries and takeaways+ Show
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All expert statements+ Show
Every expert statement below comes from the recorded discussions, with its speaker and moment.
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
The bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.
opinionTodd Ponsky0:04 ↗
A 70-degree endoscope is a difficult tool to use but useful for tracking down hard-to-find tracheoesophageal fistulas.
clinical0:37 ↗
Routine bronchoscopy is now standard practice for all type C esophageal atresia cases, though this represents a change from earlier training when it was not necessarily performed.
clinicalDan1:13 ↗
General surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.
opinionTodd Ponsky1:53 ↗
Pediatric surgery fellows at this institution complete a one-month attachment with ENT to perform bronchoscopies as part of their training.
clinical2:22 ↗
Dual scoping (simultaneous bronchoscopy and esophagoscopy) is enormously valuable for complicated TEF patients, providing different information and advantages in visualization.
clinicalDan6:41 ↗
During dual scoping, you can see the light from one scope through the epithelium, inject material that may come through subtle holes, or observe bubbles from air insufflation, making simultaneous visualization quite valuable.
clinicalPhil7:33 ↗
For combined bronchoscopy and esophagoscopy in small children, a 2.8 mm flexible bronchoscope is typically used alongside an infant gastroscope (5.4 or 6 mm outer diameter).
clinicalPhil8:19 ↗
An infant gastroscope will fit retrograde through a 16 French gastrostomy tube.
clinicalPhil8:36 ↗
The concept of endoscopic TEF repair is to demucosalize the tract because mucosa is a non-stick surface; you want raw against raw with a tiny bit of fibrin glue to seal it while it scars off.
clinical11:01 ↗
When using fibrin glue for TEF repair, use a very small amount (about 0.1 ml) via a Duplo double-lumen catheter to avoid forming a foreign body.
clinical11:36 ↗
Trichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.
clinicalTodd Ponsky12:21 ↗
When using bugbee cautery for TEF repair, place something in the esophagus (such as an endotracheal tube) as a spacer to avoid burning the back of the esophageal wall.
clinical13:36 ↗
A bugbee catheter will go down an EGD scope, allowing cauterization from the esophageal side if the tract angle is favorable.
clinical14:29 ↗
A 3 French bugbee fits through a 2.8 mm flexible bronchoscope with a 1.2 mm suction channel, providing precise control of the tip.
clinicalBob Wood15:10 ↗
When passing a bugbee through a rigid scope, bending the end at a slight angle before insertion allows steering by rotation.
clinical15:32 ↗
Endoscopic TEF repair often needs to be performed more than once; the average is approximately 2 procedures, with some requiring 1 and others 3-4 attempts.
clinical22:37 ↗
The success rate for endoscopic TEF closure is running about 80%, not 100%.
clinical24:18 ↗
After 3 or 4 failed endoscopic TEF repair attempts, it is typically time to give up and discuss alternative approaches.
clinical24:27 ↗
When cauterizing a TEF, you should particularly try to get the edges and sides because as they scar in, that will narrow the whole mouth, making re-intervention easier if needed.
clinical24:59 ↗
To reduce airway fire risk during bugbee cautery, insufflated oxygen should be kept at 30% or less.
clinical25:51 ↗
Patients can tolerate a minute or two of lower oxygen saturation during cautery procedures to maintain safe oxygen levels below 30%.
clinicalBob Wood26:10 ↗
Radiance voice gel (used for vocal cord injection) can be injected into the wall beside a TEF to obliterate the potential space and hold raw surfaces together; it only lasts a few weeks.
clinical27:05 ↗
For TEF repair, all that matters is achieving raw-on-raw tissue contact for healing.
clinicalTodd Ponsky69:25 ↗
Thoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact.
opinionTodd Ponsky69:33 ↗
Slide tracheoplasty is a useful technique for big complex TEF holes, using part of the trachea to repair the esophageal defect.
clinical30:55 ↗
Sternal periosteum is an excellent interposition graft material—it is like Kevlar, bulletproof, abundant, and very strong, though almost impossible to suture.
clinical34:02 ↗
Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation, unlike many operations where the surgeon does not matter long-term.
opinion57:09 ↗
Button batteries are extremely dangerous and can cause ongoing tissue damage that extends beyond what is visible and beyond the expected time frame.
clinicalDan43:17 ↗
The institutional protocol for button battery ingestion is to remove them within 2 hours of identification, as it is considered a medical emergency.
guidelinePhil44:04 ↗
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