Does the presence of a tracheoesophageal fistula predict the outcome of laryngeal cleft repair?

Objective: To determine if the presence of a tracheoesophageal fistula (TEF) alters outcome following laryngeal cleft repair. Design: A retrospective review of patients diagnosed and treated for laryngeal clefts, with a minimum follow-up period of 1 year. Setting: An academic tertiary care children's hospital. Patients: Twenty-five pediatric patients diagnosed and surgically treated for laryngeal cleft. Main Outcome Measures: Each chart was reviewed to determine if patients with a laryngeal cleft had been diagnosed with TEF and had undergone a surgical TEF repair procedure. The success of the surgery was evaluated based on the resolution of symptoms and the endoscopic evaluation of the repair site. Results: Twenty-five patients were reviewed for study purposes. Fourteen had a history of TEF repair and 11, no history of TEF. All 25 patients underwent surgical repair of the laryngeal cleft. Twelve of the 14 patients with a history of TEF repair experienced a breakdown of the laryngeal cleft repair. Only 1 of the 11 patients with no history of TEF experienced such a breakdown. In 8 of 9 patients with a laryngotracheoesophageal type I cleft, surgical repair was not successful. Conclusions: In our series, patients with laryngeal clefts who also had a history of TEF had a much higher incidence of breakdown of cleft repair compared with patients with no history of TEF. This finding is not conclusive and requires further investigation. The failure of cleft repair correlated with the severity of the cleft. The importance of these associations may lead to enhanced surgical planning and realistic preoperative family expectations.