Variations in the Level of Termination and Characteristics of Tracheoesophageal Fistula in Patients with Type C Esophageal Atresia

A BSTRACT Aim: To study the level of termination of the tracheoesophageal fistula (TEF) and the characteristics of the lower esophagus in gross type C TEF. Materials and Methods: In this prospective observational study, the distance between the arch of the azygos vein, the TEF, the upper esophageal end and total gap length were measured directly at thoracotomy. The patients were divided into three groups based on total gap length; Group A, B and C (≤1 cm; 1.1–2 cm; and ≥2.1 cm). The characteristics of the lower esophagus (thin/thick and narrow/wide) were noted. Results: Out of 60, Group A, B, and C had 23 (38.3%), 21 (35%), and 16 (26.7%) patients, respectively. The TEF terminated above, at, and below the azygos vein in 15 (25%), 6 (10%), and 39 (65%) patients, respectively, with the range of 15 mm above to 11 mm below; the commonest site being 5 mm below ( n = 26, 43.3%) the vein. The patients with TEF above and at the level of the azygos vein were predominantly in Group A ( n = 21, 95.2%), and those below were predominantly in Group B and C ( n = 36, 92.3%; P < 0.01). A narrow lumen and thin-walled lower esophagus were significantly higher ( n = 15, P = 0.001; n = 10; P = 0.003) in Group C patients. Conclusions: The level of termination of the TEF in Gross type C TEF is inconsistent, the commonest site being 5 mm below the azygos vein. The lower the opening of the TEF below the azygos, the higher the total gap length with thinner and narrow lower esophagus carrying important surgical implications.