Prevalence and type of respiratory issues following Tracheo-Oesophageal fistula repair in children and young people: A systematic review

Why clinicians should know about it

• Picked for Pediatric Surgery (paper of the day, 16 October 2026): Systematic review of respiratory outcomes after TOF repair

Abstract

BACKGROUND: Tracheo-oesophageal fistula (TOF) is a rare congenital anomaly requiring early surgical correction. Despite improved survival, long-term respiratory morbidity remains significant and under-characterised. This review aimed to evaluate the prevalence and nature of respiratory complications following TOF repair in paediatrics. METHODS: A systematic review was conducted in accordance with PRISMA guidelines. Six databases were searched (2004-2025). Eligible studies reported respiratory outcomes following complete TOF repair in paediatric populations. Screening, data extraction, and quality appraisal were performed independently by two reviewers. Pooled prevalence estimates were calculated. RESULTS: Twenty studies (n = 2,214) were included, predominantly retrospective observational studies with heterogeneous outcome definitions. Respiratory morbidity was consistently reported. The highest pooled prevalence estimates were recurrent cough (57.2%), pneumonia/LRTI (50.08%), and airway malacia (40.62%). Bronchiectasis (11.96%) and atelectasis (20.78%) were less frequent. CONCLUSIONS: Respiratory morbidity post-TOF repair is common and multifactorial, highlighting the need for structured, multidisciplinary long-term follow-up and improved standardisation in future research.

Abstract as published, via PubMed.