WOFAPS 2025 8th World Congress of Pediatric Surgery

Wenfang Huang

Department of Anesthesiology, Children’s Hospital, Zhejiang University School of Medicine

Objective: This study aimed to explore a novel airway management strategy using a percutaneous transluminal coronary angioplasty (PTCA) balloon catheter to occlude the fistula, evaluating its feasibility and advantages in esophageal atresia/tracheoesophageal fistula (EA/TEF) surgery.

Methods: A Type C esophageal atresia patient with a tracheoesophageal fistula, whose fistula is located approximately 1.5 cm from the tracheal carina, underwent preoperative measurement of the fistula size, and an appropriately sized PTCA balloon dilation catheter was selected。Anesthesia induction was performed using esketamine, dexmedetomidine, and sevoflurane with spontaneous breathing. After topical anesthesia with 1% lidocaine under nasal fiberoptic bronchoscopy guidance, both the bronchoscope and PTCA catheter were inserted under videolaryngoscope assistance to locate the fistula and place the balloon for occlusion. Subsequently, an endotracheal tube was inserted, and after confirming proper balloon positioning, controlled ventilation was initiated. The surgery was performed via thoracoscopy in the lateral decubitus position, with intraoperative blood gas monitoring to maintain stable ventilation. Postoperatively, the patient was transferred to the ICU with the endotracheal tube in place

Results: The PTCA balloon catheter successfully occluded the fistula, with no intraoperative gastric distension, reflux, or hypoxemia observed. Ventilation was effective。

Conclusion: The PTCA balloon dilation catheter can effectively seal the fistula, preventing air leakage and gastric distension. Its soft material minimizes the risk of airway compression, thereby reducing post-compression complications. This study provides new insights into the perioperative anesthetic management of tracheoesophageal fistula。