[Transternal Transpericardic Approach in the Treatment of a Recurrent Tracheoesophageal Fistula]. / Abordagem Transesternal Transpericárdica no Tratamento de Fístula Traqueo-Esofágica Recorrente.

Recurrent tracheoesophageal fistula in children is a challenging issue, associated to high morbidity and mortality, due to major scarring and inflammatory changes resulting from previous interventions and the disease itself. Most cases require surgical treatment, but the complexity of the situation may, sometimes, prevent the traditional approach by thoracotomy. We present the clinical case of a 2 year old child with esophageal atresia with proximal and distal fistula, and multiple fistula recurrences. After the fourth recurrence it was decided to use a transternal transpericardic approach to the trachea, with resection of two tracheal rings, ligation of esophageal portion of the fistula, interposition of autologous pericardium and tracheal anastomosis. Although this technique has been used in congenital or acquired tracheal stenosis in children, this is the first report in the literature on its use in recurrent tracheoesophageal fistula.