Research Information System
Journal of Pediatric Surgery, vol.61, no.7, 2026 (SCI-Expanded, Scopus)
Background: Recurrent tracheoesophageal fistula (rTEF) is a rare but serious complication after esophageal atresia (EA) repair. Although various surgical and endoscopic techniques are available, the optimal management remains controversial due to limited data and heterogeneous outcomes. Purpose: To systematically review and compare the outcomes of surgical and endoscopic interventions for rTEF in pediatric patients. Methods: A systematic literature search was conducted in PubMed, MEDLINE, and EMBASE for studies published between January 2015 and January 2025. Twenty-seven eligible studies involving 789 children with rTEF were analyzed. Treatment modalities were classified as open surgical management (OSM), thoracoscopic surgical management (TSM), or endoscopic management (EM). Data on demographics, treatment type, and outcomes were descriptively summarized. Results: The overall incidence of rTEF was 7.17 %. The success rates were 92.9 % for OSM, 86.4 % for TSM, and 67.2 % for EM. Major risk factors were esophageal stricture and anastomotic leakage. Re-recurrence rates ranged from 8.9 % to 21.7 % in surgically treated patients. EM frequently required repeated sessions, and a substantial proportion of patients ultimately underwent surgical repair due to persistent fistula or recurrent symptoms. Conclusions: Open and thoracoscopic repair remain the most effective treatments for rTEF, while endoscopic methods serve as minimally invasive adjuncts. Standardized definitions and multicenter prospective studies are required to establish an evidence-based treatment algorithm and to improve either short- or long-term outcomes in children with rTEF.