Background To present the clinical characteristics, diagnostic approach, therapeutic management, and outcomes of congenital H-type tracheoesophageal fistula (H-TEF) based on the experience of the National Center for Children’s Health in China. Methods A retrospective review of patients with H-TEF from 2007 to 2025 was performed. Patients were stratified by the occurrence of major complications (Clavien-Dindo grade ≥ III) for comparative analysis. Univariate analyses were performed to identify associated risk factors. Results The study cohort comprised 51 patients. The median age at diagnosis was 1 month. Bronchoscopy demonstrated the highest detection rate (100%), followed by upper gastrointestinal contrast study (UGI) (96%). None of the patients who underwent precise fistula localization (with placement of a polyester traction suture) developed anastomotic leakage or recurrent fistula. The overall complication rate was 41.2%, with a major complication rate of 29.4%. No statistically significant risk factors for major complications were identified within this cohort. Conclusions Modifying patient positioning during UGI can enhance its diagnostic ability. Precise localization of the fistula tract and the use of nerve monitoring may help minimize postoperative complications. While no risk factors achieved statistical significance, the study was not powered to exclude potential clinically relevant effects. Impact <UnorderedList Mark="Bullet"> <ItemContent> An upper gastrointestinal contrast study can reach a diagnostic yield of 96% under proper positioning during the procedure. </ItemContent> <ItemContent> Intraoperative precision localization of the fistula demonstrated favorable outcomes and reduced surgical complexity. </ItemContent> <ItemContent> No recurrent laryngeal nerve injury occurred in any patient who underwent intraoperative nerve monitoring (overall incidence 13.73%). </ItemContent> <ItemContent> Complications occurred in 41.2% (29.4% major). No statistically significant risk factors were detected, although clinical effects cannot be entirely ruled out due to the limited cohort size. </ItemContent> <ItemContent> Despite representing the largest reported cohort in China to date, future prospective, multi-center studies with extended follow-up are warranted. </ItemContent> </UnorderedList>

Congenital H-type tracheoesophageal fistula: Experience from a large Chinese center

期刊论文
发表日期：

2026年5月7日

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Yong Zhao,
Zonghan Li,
Shihui Tan,
Junmin Liao,
Shuangshuang Li,
Dingding Wang,
Kaiyun Hua,
Yichao Gu,
Yanan Zhang,
Xinyue Tan,
Zhaohong Zheng,
Jinghua Jiao,
Dan Don,
Dayan Sun,
Jinshi Huang

摘要

Background

To present the clinical characteristics, diagnostic approach, therapeutic management, and outcomes of congenital H-type tracheoesophageal fistula (H-TEF) based on the experience of the National Center for Children’s Health in China.

Methods

A retrospective review of patients with H-TEF from 2007 to 2025 was performed. Patients were stratified by the occurrence of major complications (Clavien-Dindo grade ≥ III) for comparative analysis. Univariate analyses were performed to identify associated risk factors.

Results

The study cohort comprised 51 patients. The median age at diagnosis was 1 month. Bronchoscopy demonstrated the highest detection rate (100%), followed by upper gastrointestinal contrast study (UGI) (96%). None of the patients who underwent precise fistula localization (with placement of a polyester traction suture) developed anastomotic leakage or recurrent fistula. The overall complication rate was 41.2%, with a major complication rate of 29.4%. No statistically significant risk factors for major complications were identified within this cohort.

Conclusions

Modifying patient positioning during UGI can enhance its diagnostic ability. Precise localization of the fistula tract and the use of nerve monitoring may help minimize postoperative complications. While no risk factors achieved statistical significance, the study was not powered to exclude potential clinically relevant effects.

Impact

An upper gastrointestinal contrast study can reach a diagnostic yield of 96% under proper positioning during the procedure.

Intraoperative precision localization of the fistula demonstrated favorable outcomes and reduced surgical complexity.

No recurrent laryngeal nerve injury occurred in any patient who underwent intraoperative nerve monitoring (overall incidence 13.73%).

Complications occurred in 41.2% (29.4% major). No statistically significant risk factors were detected, although clinical effects cannot be entirely ruled out due to the limited cohort size.

Despite representing the largest reported cohort in China to date, future prospective, multi-center studies with extended follow-up are warranted.