Slide tracheoplasty for repair of complex tracheoesophageal fistulas in children: A salvage technique.

Objective: Complex tracheoesophageal fistula (TEF), encompassing recurrent, large-defect, or foreign-body-induced TEF caused by congenital or acquired origin, represents a formidable surgical challenge. Although various endoscopic and surgical techniques have been developed, the optimal approach remains controversial. Slide tracheoplasty with cardiopulmonary bypass provides excellent exposure of both the trachea and esophagus, making it a potentially valuable salvage technique for the treatment of complex TEF in children. We present a series of patients who underwent successful slide tracheoplasty by a multidisciplinary team in our institution. Methods: We retrospectively reviewed 3 consecutive patients who underwent slide tracheoplasty for complex TEF between January and April 2024. Data collected included demographic characteristics, etiology, surgical details, perioperative parameters, and outcomes. Results: All 3 patients successfully underwent slide tracheoplasty and esophageal repair with cardiopulmonary bypass support. All patients were successfully weaned from mechanical ventilation and had an uneventful recovery. At a median follow-up of 12 months, there were no cases of postoperative infection, vocal cord paralysis, esophageal or tracheal strictures, recurrent fistula, or need for reintervention. Conclusions: Slide tracheoplasty with cardiopulmonary bypass demonstrates excellent early outcomes for the management of complex tracheoesophageal fistula in children. This technique represents a promising salvage option when conventional repair approaches are inadequate or have failed.