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Tracheoesophageal Fistula
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Every child with esophageal atresia should undergo bronchoscopy at their initial trip to the operating room. — Aaron Garrison, Esophageal Atresia in Brief: Presentation, Workup, Diagnosis, and Treatment · 5:57
Esophageal Atresia in Brief: Presentation, Workup, Diagnosis, and Treatment
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Esophageal atresia is an important diagnosis for pediatric surgeons to understand. Here, we review the basics of esophageal atresia and tracheoesophageal fistula with Dr. Daniel von Allmen and Dr. Aaron Garrison from Cincinnati Children's H
video · Feb 2022
Esophageal Atresia & Tracheoesophageal Fistula (EA/TEF) Types Explained for Pediatric Surgery
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This video provides a clear, visual explanation of Esophageal Atresia (EA) and Tracheoesophageal Fistula (TEF), common congenital anomalies in pediatric surgery. Jill Knepprath, MD demonstrates normal anatomy and then breaks down the differ
video2:11 · Sep 2026
Conventional wisdom is to perform left thoracotomy for right-sided aortic arch — Daniel von Allmen, Tracheoesophageal Fistula with Dr. Daniel von Allmen · 7:27
Thoracoscopic Repair of Tracheo-esophageal Fistula Tricks: Pediatric Surgery...
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During the Pediatric Surgery Tricks of the Trade and Difficult Cases: Innovative Solutions to Common Problems Course in 2013, Dr. Atsuyuki Yamataka discusses preoperative gap assessment and thoracoscopic repair intracheoesophageal fistula w
video19:14 · Sep 2018
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
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Dr. Michael Rutter presents multiple case studies of patients with esophageal fistulas and repair approaches to each.
video1:48:11 · Jan 2019
EA/TEF Discussion & Technique: Difficult Cases
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Dr. Atsuyuki Yamataka discusses measuring the residual TEF, thoracoscopic repair, and preoperative gap assessment. He also demonstrates his laparoscopic technique for repair of TEF.
video19:33 · Jan 2019
Update Course 2013: EA & TEF
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Dr. Robert Parry from Akron Children's Hospital leads a comprehensive discussion of esophageal atresia and tracheo-esophageal fistulas. Topics include initial management, operative management, pre-operative echocardiogram, chest tube, thora
video38:25 · Jan 2019
Tips and Tricks: EA & TEF
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Dr. Steven Rothenberg leads a discussion on tips and tricks that are useful in operative and post-operative management of esophageal atresia and tracheoesophageal fistula.
video9:27 · Jan 2019
Introduction and Panel Discussion: EA & TEF
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Dr. Todd Ponsky from Akron Children's Hospital leads a discussion on esophageal atresia and tracheoesophageal fistula. Topics during this introductory discussion include operative approaches, utilization of bronchoscopy, and esophageal moti
video36:02 · Jan 2019
Long Gap Discussion: EA & TEF
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Dr. Todd Ponsky moderates a panel discussion on the work-up of long gap esophageal atresia.
video10:16 · Jan 2019
Tracheoesophageal Fistula with Dr. Daniel von Allmen
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This podcast discusses the work up, operative management, and follow-up management of tracheoesophageal fistulas. Dr. Todd Ponsky is an associate professor of surgery and pediatrics and pediatric surgeon at Akron Children's Hospital. Dr. Av
podcast45:21 · Dec 2020
Treatment for Long Gap Esophageal Atresia: Esophageal Elongation and Replacement
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Pediatric surgeons Dr. Daniel Von Allmen and Dr. Todd Ponsky from Cincinnati children's Hospital discussing the technique for treating long gap esophageal atresia. For additional info please visit: https://www.youtube.com/c/CincinnatiChildr
podcast10:56 · Jan 2022
Esophageal Replacement with Dr. Dan von Allmen
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In this episode we are talking about esophageal atresia, challenges and techniques for reconnection, and replacement methods when conservation isn't possible with Dr. Dan von Allmen, he’s the surgeon-in-chief at Cincinnati Children’s Hospit
podcast13:51 · Nov 2023
QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter
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Cincinnati Children's hosted the QUAD conference in October 2022 which was a combination of four conferences: The international organization for is Esophageal atresia, the Aerodigestive Society Conference, the Cincinnati Children's Airway c
video7:37 · Mar 2024
Dr. Marc Michalsky - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
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Marc Michalsky, MD, MBA, FACS, FAAP, FASMBS - Pediatric Robotic-Assisted Surgery – Developing a Programmatic Paradigm
Surgical Grand Rounds (October 29, 2025)
video1:06:48 · Oct 2025
NEC small bowel stricture
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Surgical content by Dr. Steve Rothenberg — Abdominal Surgery
video7:47 · May 2026
For circumferential erosions that look bad, re-scoping to look for stricture formation is recommended. — Dan, Button Battery Ingestion · 10:43
Leak after Esophageal Atresia Repair / TEF Repair: Discussion of World Experts
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Following Dr. Arnold Coran's presentation on recurrent tracheoesophageal fistulae, Dr. Todd Ponsky moderates a discussion on the subject. Topics include the utility of post-operative contrast studies, management of leaks, and dealing with c
video15:25 · Jan 2019
Button Battery Ingestion
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At the 7th Annual Pediatric Surgery Update Course, Dr. Daniel von Allmen discusses management after button battery ingestion.
video14:28 · Mar 2020
Update Course Rewind 2025: The Recurrent TEF Problem
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This video, featuring experts from Cincinnati Children's, discusses the challenging management of recurrent tracheoesophageal fistula (TEF) years after initial repair. Dr. Douglas von Allmen presents a clinical scenario and highlights the r
video2:20 · Jul 2026
Due to recent studies implicating transanastomotic feeding tubes as an independent risk factor for postoperative strictures, Montreal Children's Hospital initiated a moratorium on their use until evaluating their own outcomes. — Catherine LaRusso, APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso · 2:35
Thoracoscopic TEF Repair, Is It Really Better Than Open? Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course,Dr. Alexander Gibbons discusses the history of surgical repair oftracheoesophageal fistulas, with focus on the controversy of thoracoscopic versus open TEF repair.
video18:17 · Sep 2018
Journal of Pediatric Surgery Article Review: December 2021
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Here's your latest podcast with the highlights from the December issue of JPS. We're joined by Editor-in-Chief, Dr. Whit Holcomb, as well as authors, Drs. Louise Montalva, Shaun Kunisaki, and Shawn St. Peter. Hosts: Ellen Encisco & Rod Gera
podcast16:39 · Jan 2022
APSA - Effect of transanastomotic feeding tubes on anastomotic strictures in patients with esophageal atresia and tracheoesophageal fistula- the Quebec experience - Kathryn LaRusso
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Listen to Kathryn LaRusso gave her presentation of "Effect of
transanastomotic feeding tubes on anastomotic strictures in patients
with esophageal atresia and tracheoesophageal fistula- the Quebec
experience" at the first ever Best of th
video8:52 · May 2022
Case Based Journal Review: Esophageal Atresia in 2022
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Dr. José Campos is back, this time helping us review some of the latest literature on the diagnosis and management of Esophageal Atresia in children. In this podcast, we're reviewing a typical case with Dr. Todd Ponsky and incorporating lit
podcast17:55 · Aug 2022
Quick Literature Updates Episode 9
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We’re back with ninth episode of "Quick Literature Updates" the podcast series that delivers the latest updates in pediatric surgery literature in a quick and digestible format. In each episode, we review four articles covering the most int
video · Jun 2023
Button batteries can cause ongoing tissue injury for weeks after ingestion, even if 'dead' (they retain ~2 volts); institutional protocol mandates removal within 2 hours of identification. — Michael Rutter, Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula · 53:37
Aerodigestive & Esophageal Surgery - Difficult Tracheal Esophageal Fistula
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Dr. Todd Ponsky introduces the seminar covering complexities in the management of Tracheal Esophageal Fistula (TEF). Points of interest will include discussion around the "unsalvageable esophagus" and diagnosis of TEF. Dr. Michael Rutter, P
video2:00:59 · Nov 2018
Interesting Case Presentations Part II: EA/TEF
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Dr. Wolfgang Stehr, Dr. Cynthia Reyes, Dr. Amber Shada, Dr. Matias Bruzoni, and Dr. Kamalesh Pal present further interesting cases related to esophageal atresia and tracheoesophageal fistula.
video1:06:11 · Jan 2019
Rigid Bronchoscopy for Diagnosis and Treatment of Proximal Pouch Fistula in...
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video4:26 · Feb 2020
Rigid Bronchoscopy for Diagnosis and Treatment of Proximal Pouch Fistula in...
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video4:26 · Feb 2020
Conventional wisdom for right-sided aortic arch is to perform left thoracotomy rather than right thoracotomy — Daniel von Allmen, Tracheoesophageal Fistula with Dr. Daniel von Allmen · 7:27
Esophageal Atresia
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Comprehensive discussion of esophageal atresia and esophageal fistulas by Robert Parry. Initial management, operative management, pre operative echocardiogram, chest tube, thoracoscopic versus open esophageal atresia,TEF repair, long gap es
video39:30 · Nov 2018
Tracheoesophageal Fistula with Dr. Daniel von Allmen
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This podcast discusses the work up, operative management, and follow-up management of tracheoesophageal fistulas. Dr. Todd Ponsky is an associate professor of surgery and pediatrics and pediatric surgeon at Akron Children's Hospital. Dr. Av
video45:21 · Jan 2019
Ladd Medal Award Presentation Honoring Dr. Steven Rothenberg's Pioneering Minimally Invasive Pediatric Surgery
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Surgical content by Dr. Steve Rothenberg — Lectures & Presentations
video33:12 · May 2026
Parental factors associated with anxiety and depression in EA/TOF include parents' younger age, perceived lack of support, caring stress, and financial worries. — Vuko Wallace, ERNICA Research Collaboration - Mental health of parents in the context of EA/TOF · 17:00
ERNICA Research Collaboration - Mental health of parents in the context of EA/TOF
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The title of this webinar is: Research findings on mental health of parents in the context of esophageal atresia (EA) / tracheoesophageal fistula (TEF): recommendations for digitalised psychological support. This interactive webinar aims to
video50:07 · Dec 2023
Flexible bronchoscopy is used starting in the nose and ending in the subsegmental bronchi, and bronchoalveolar lavage helps with identification of infections and markers of aspiration. — Sherry Torres Silva, QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team · 8:49
QUAD #27 - Multidisciplinary - How Do Teams Enhance Outcomes by the CCHMC ADEC Team
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In this special episode from the QUAD Conference hosted by Cincinnati Children’s, Lizzy Lee takes us inside one of the world’s largest and most advanced multidisciplinary programs for children with complex airway and digestive conditions: t
video10:19 · Apr 2025
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Expert statements from the recordings in this collection.
TEF Presentations (Extended): Aerodigestive & Esophageal Surgery
The bugbee cautery is useful and underutilized among general surgeons for treating recurrent tracheoesophageal fistulas.
opinionTodd Ponsky0:04 ↗
A 70-degree endoscope is a difficult tool to use but useful for tracking down hard-to-find tracheoesophageal fistulas.
clinical0:37 ↗
Routine bronchoscopy is now standard practice for all type C esophageal atresia cases, though this represents a change from earlier training when it was not necessarily performed.
clinicalDan1:13 ↗
General surgeons may underappreciate tracheomalacia or laryngomalacia, making collaboration with ENT colleagues valuable for comprehensive airway assessment.
opinionTodd Ponsky1:53 ↗
Pediatric surgery fellows at this institution complete a one-month attachment with ENT to perform bronchoscopies as part of their training.
clinical2:22 ↗
Dual scoping (simultaneous bronchoscopy and esophagoscopy) is enormously valuable for complicated TEF patients, providing different information and advantages in visualization.
clinicalDan6:41 ↗
During dual scoping, you can see the light from one scope through the epithelium, inject material that may come through subtle holes, or observe bubbles from air insufflation, making simultaneous visualization quite valuable.
clinicalPhil7:33 ↗
For combined bronchoscopy and esophagoscopy in small children, a 2.8 mm flexible bronchoscope is typically used alongside an infant gastroscope (5.4 or 6 mm outer diameter).
clinicalPhil8:19 ↗
An infant gastroscope will fit retrograde through a 16 French gastrostomy tube.
clinicalPhil8:36 ↗
The concept of endoscopic TEF repair is to demucosalize the tract because mucosa is a non-stick surface; you want raw against raw with a tiny bit of fibrin glue to seal it while it scars off.
clinical11:01 ↗
When using fibrin glue for TEF repair, use a very small amount (about 0.1 ml) via a Duplo double-lumen catheter to avoid forming a foreign body.
clinical11:36 ↗
Trichloroacetic acid (TCA) can be used for TEF demucosalization, but it is difficult to control precisely and leaves white tissue everywhere, whereas the bugbee provides more precise control.
clinicalTodd Ponsky12:21 ↗
When using bugbee cautery for TEF repair, place something in the esophagus (such as an endotracheal tube) as a spacer to avoid burning the back of the esophageal wall.
clinical13:36 ↗
A bugbee catheter will go down an EGD scope, allowing cauterization from the esophageal side if the tract angle is favorable.
clinical14:29 ↗
A 3 French bugbee fits through a 2.8 mm flexible bronchoscope with a 1.2 mm suction channel, providing precise control of the tip.
clinicalBob Wood15:10 ↗
When passing a bugbee through a rigid scope, bending the end at a slight angle before insertion allows steering by rotation.
clinical15:32 ↗
Endoscopic TEF repair often needs to be performed more than once; the average is approximately 2 procedures, with some requiring 1 and others 3-4 attempts.
clinical22:37 ↗
The success rate for endoscopic TEF closure is running about 80%, not 100%.
clinical24:18 ↗
After 3 or 4 failed endoscopic TEF repair attempts, it is typically time to give up and discuss alternative approaches.
clinical24:27 ↗
When cauterizing a TEF, you should particularly try to get the edges and sides because as they scar in, that will narrow the whole mouth, making re-intervention easier if needed.
clinical24:59 ↗
To reduce airway fire risk during bugbee cautery, insufflated oxygen should be kept at 30% or less.
clinical25:51 ↗
Patients can tolerate a minute or two of lower oxygen saturation during cautery procedures to maintain safe oxygen levels below 30%.
clinicalBob Wood26:10 ↗
Radiance voice gel (used for vocal cord injection) can be injected into the wall beside a TEF to obliterate the potential space and hold raw surfaces together; it only lasts a few weeks.
clinical27:05 ↗
For TEF repair, all that matters is achieving raw-on-raw tissue contact for healing.
clinicalTodd Ponsky1:09:25 ↗
Thoracoscopic diaphragmatic hernia repairs may have a higher recurrence rate than open repairs, possibly because they do not cause enough raw-on-raw tissue contact.
opinionTodd Ponsky1:09:33 ↗
Slide tracheoplasty is a useful technique for big complex TEF holes, using part of the trachea to repair the esophageal defect.
clinical30:55 ↗
Sternal periosteum is an excellent interposition graft material—it is like Kevlar, bulletproof, abundant, and very strong, though almost impossible to suture.
clinical34:02 ↗
Slide tracheoplasty appears to be a learning-curve, surgeon-dependent operation, unlike many operations where the surgeon does not matter long-term.
opinion57:09 ↗
Button batteries are extremely dangerous and can cause ongoing tissue damage that extends beyond what is visible and beyond the expected time frame.
clinicalDan43:17 ↗
The institutional protocol for button battery ingestion is to remove them within 2 hours of identification, as it is considered a medical emergency.
guidelinePhil44:04 ↗
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