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Congenital H-type tracheoesophageal fistula: Experience from a large Chinese center

Pediatric Research (2026)Cite this article

Abstract

Background

To present the clinical characteristics, diagnostic approach, therapeutic management, and outcomes of congenital H-type tracheoesophageal fistula (H-TEF) based on the experience of the National Center for Children’s Health in China.

Methods

A retrospective review of patients with H-TEF from 2007 to 2025 was performed. Patients were stratified by the occurrence of major complications (Clavien-Dindo grade ≥ III) for comparative analysis. Univariate analyses were performed to identify associated risk factors.

Results

The study cohort comprised 51 patients. The median age at diagnosis was 1 month. Bronchoscopy demonstrated the highest detection rate (100%), followed by upper gastrointestinal contrast study (UGI) (96%). None of the patients who underwent precise fistula localization (with placement of a polyester traction suture) developed anastomotic leakage or recurrent fistula. The overall complication rate was 41.2%, with a major complication rate of 29.4%. No statistically significant risk factors for major complications were identified within this cohort.

Conclusions

Modifying patient positioning during UGI can enhance its diagnostic ability. Precise localization of the fistula tract and the use of nerve monitoring may help minimize postoperative complications. While no risk factors achieved statistical significance, the study was not powered to exclude potential clinically relevant effects.

Impact

  • An upper gastrointestinal contrast study can reach a diagnostic yield of 96% under proper positioning during the procedure.

  • Intraoperative precision localization of the fistula demonstrated favorable outcomes and reduced surgical complexity.

  • No recurrent laryngeal nerve injury occurred in any patient who underwent intraoperative nerve monitoring (overall incidence 13.73%).

  • Complications occurred in 41.2% (29.4% major). No statistically significant risk factors were detected, although clinical effects cannot be entirely ruled out due to the limited cohort size.

  • Despite representing the largest reported cohort in China to date, future prospective, multi-center studies with extended follow-up are warranted.

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Fig. 1: Techniques for fistula tract localization.
The alternative text for this image may have been generated using AI.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available due to privacy restrictions, but are available from the corresponding author on reasonable request.

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Acknowledgements

None.

Funding

This work was supported by Beijing Municipal Science & Technology Commission (Z211100002921062) and Natural Science Foundation of Tibet Autonomous Region (XZZR20242020[W]).

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Author notes

  1. These authors contributed equally: Yong Zhao, Zonghan Li, Shihui Tan.

Authors and Affiliations

  1. Department of Neonatal Surgery, Beijing Children’s Hospital, Capital Medical University, National Center for Children’s Health, Beijing, 100045, China

    Yong Zhao, Zonghan Li, Shihui Tan, Junmin Liao, Shuangshuang Li, Dingding Wang, Kaiyun Hua, Yichao Gu, Yanan Zhang, Xinyue Tan, Zhaohong Zheng, Jinghua Jiao, Dayan Sun & Jinshi Huang

  2. Department of Pediatric Surgery, Lhasa People’s Hospital, Lhasa, Tibet Autonomous Region, China

    Yong Zhao & Dan Don

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Contributions

Yong Zhao contributed to the study’s conception and design, acquisition of data, and critical revision of the manuscript for important intellectual content. Zonghan Li and Shihui Tan contributed to the conception and design, acquisition of data, analysis and interpretation of data, and drafting of the article. Junmin Liao, Shuangshuang Li, Dingding Wang, Kaiyun Hua, Yichao Gu, Yanan Zhang, Xinyue Tan, Zhaohong Zheng, Jinghua Jiao, Dan Don, and Dayan Sun contributed to the acquisition of data and interpretation of data. Jinshi Huang contributed to the study’s conception and design and final approval of the version to be published.

Corresponding author

Correspondence to Jinshi Huang.

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Competing interests

The authors declare no competing interests.

Consent statement

This retrospective chart review study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study obtained approval from the Ethics Committee of Beijing Children’s Hospital, Capital Medical University (Ethical approval ID: 2019-k-333). Individual consent for this retrospective analysis was waived.

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Zhao, Y., Li, Z., Tan, S. et al. Congenital H-type tracheoesophageal fistula: Experience from a large Chinese center. Pediatr Res (2026). https://doi.org/10.1038/s41390-026-05050-z

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