Jia Liu

Introduction: Managing recurrent congenital tracheoesophageal fistula (rTEF) is clinically challenging. Repeat thoracotomy is technically demanding due to dense adhesions and carries high morbidity, whereas outcomes of conventional endoscopic interventions vary, and sustained closure may be difficult to achieve in complex recurrent fistulas. We report the use of bronchoscopy-guided intratracheal suturing in a refractory case. Case Presentation: A 17-year-old male with a history of congenital TEF experienced multiple recurrences despite two thoracotomies and one endoscopic clipping attempt. The procedure was performed under general anesthesia without endotracheal intubation, and superimposed high-frequency jet ventilation was used for airway management. Following electrocautery treatment of the visible tracheal-side margins, four interrupted absorbable sutures were placed through tissues adjacent to the fistula opening under bronchoscopic guidance. Tightening of the sutures approximated the visible fistula margins. The procedure lasted 62 min with no complications. Follow-up bronchoscopy, methylene blue testing, and esophagography at 2 weeks showed no evidence of fistula leakage, indicating early technical closure. At the 3-month telephone follow-up, the patient remained asymptomatic and reported normal oral intake and physical activity. These findings suggest early technical success; longer objective follow-up is required to assess durability. Conclusions: In this highly selected adolescent, bronchoscopy-guided intratracheal suturing was technically feasible and achieved early fistula closure without a perioperative complication. Longer objective follow-up after loss of suture tensile strength is required to determine whether closure can be maintained without mechanical suture support.