Update Course Rewind 2025: The Recurrent TEF Problem
With Dr. Douglas von Allmen · hosted by Dr. Jill Knepprath
Chapter 1 of 4 · Fundamentals
Introduction
Introduction to Recurrent TEF Management
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter
CCHMC Pediatric Surgery · 7 min · Published Mar 2024
Video
Glycopyrrolate for Anastomtic Dehiscence in Esophageal Atresia
2 min · Published May 2017
Video
Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery
2 min · Published Sep 2026
Video
Leak after Esophageal Atresia Repair / TEF Repair: Discussion of World Experts
Dr. Todd Ponsky · 15 min · Published Dec 2012
Video
Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018
18 min · Published Aug 2018
Video
Thoracoscopic Repair of Tracheo-esophageal Fistula Tricks: Pediatric Surgery...
19 min · Published Jul 2017
What the experts said
A 7-year-old patient with history of TEF-EA repair presented with chronic cough and food impaction.
The patient was referred for esophageal diverticulum and underwent airway evaluation.
Esophagoscopy showed a ledge formation at the esophageal anastomosis with a dilated upper pouch.
Second fistulas or H-type fistulas can be very difficult to manage endoscopically.
The transtracheal technique involves performing a distal tracheotomy, using bronchoscopy to localize the fistula level, then making a tracheotomy over the fistula to work through and divide the esophageal layers.
Recurrent laryngeal nerve injury is underreported.
True recurrent laryngeal nerve paralysis leads to muscle atrophy over time, resulting in long-term voice problems and potential aspiration issues.
Recurrent tracheoesophageal fistulas can develop years after initial TEF repair.
Esophageal dilations were performed without improvement.
Bronchoscopy revealed granulation tissue along the back wall of the airway.
The recurrent laryngeal nerve is at risk of damage during repair of recurrent TEFs.
A transtracheal approach provides better surgical exposure and reduces risk to the recurrent laryngeal nerve.
The transtracheal approach helps minimize injury to the recurrent laryngeal nerve.