Use of free thymic fat pad for recurrent tracheoesophageal fistula operation following esophageal atresia repair

Abstract

A 2-month-old boy who had undergone radical surgery for esophageal atresia at 10 h after birth started to present intermittent choking and coughing during suckling and sleep. Upper gastrointestinal series revealed recurrent tracheoesophageal fistula at the Th3 level. Enteral feeding via trans-jejunal tube was started and reoperation was performed at 10 months old, when he weighed 9.6 kg (+0.56SD). Thoracotomy was performed after inserting the guidewire into the fistula under both bronchoscopy and gastroscopy. The fistula was resected and both esophageal and tracheal ends were sutured. Part of the thymus was obtained and the free thymic fat pad (FTFP) was interposed between sutured sites along with the application of fibrin-glue to the affected area to prevent re-recurrence. Postoperative course was uneventful and computed tomography (CT) at 1 month following the operation demonstrated the residual FTFP. FTFP can be a feasible, useful, and effective option for interposition in recurrent TEF surgery, compared to conventional pedicled or free tissue.

Keywords

• Esophageal atresia
• Fat pad
• Recurrence
• Thymus
• Tracheoesophageal fistula