CRP7 CASE SERIES OF TRACHEOESOPHAGEAL FISTULA: LONG-TERM RESPIRATORY AND GASTROINTESTINAL COMPLICATIONS IN TERTIARY CENTER IN PULAU PINANG

Geraldine Chow, Nicholas Chang,Yi Cheau Chua
Penang General Hospital, Malaysia

Introduction
Tracheoesophageal fistula (TOF) is a common congenital anomaly requiring early neonatal surgical correction. Despite timely intervention, long-term complications, especially respiratory and gastrointestinal—are frequent and challenging to manage.

Objectives
To review the spectrum of TOF related complications and its outcome.

Methodology
We reviewed a cohort of 11 patients with TOF followed at our tertiary centre, aged 1 year 11 months to 25 years. TOF subtypes included Type C (n=4), Type B (n=1), Type D (n=1); five patients had unspecified subtypes. All underwent primary repair within the first 48 hours of life.

Results
Airway complications were prominent. Tracheomalacia or tracheobronchomalacia was noted in 10 patients, with two requiring tracheostomy and non-invasive ventilation. One patient had asymptomatic tracheal stenosis; three had tracheal diverticula. Recurrent pneumonia was documented in 7 patients, while 4 were diagnosed with achalasia. GERD was a near-universal finding.
Non-invasive ventilation (CPAP) was commonly employed, with weaning durations ranging from 4 months to 6 years. Interestingly, CPAP duration did not consistently reflect the severity of malacia. One patient with tracheobronchomalacia weaned by age 1, while another required support until age 6.
Nutritional challenges were significant. Only 3 patients achieved adequate weight gain; all three had fewer complications and no recurrent pneumonia. The youngest patient remains critically ill, dependent on tracheostomy ventilation due to segmental bronchial stenosis, with associated congenital heart disease.

Conclusion
This case series underscores the chronic and multifaceted nature of TOF-related complications despite early surgical correction. Long-term respiratory support, surveillance of GERD, and nutritional optimization are critical components of care. Regular multidisciplinary follow-up is essential to mitigate morbidity and improve quality of life.