CASE REPORT article
Front. Pediatr.
Sec. Pediatric Surgery
Volume 13 - 2025 | doi: 10.3389/fped.2025.1639780
This article is part of the Research TopicAdvances and Challenges in Neonatal Surgery: Congenital and Acquired ConditionsView all 31 articles
Complications of Thoracoscopic TEF Clipping for Fistula Ligation: A Case Report of Polymer Clip Migration into the Right Main Bronchus and Recurrent Fistula
Provisionally accepted
Annika Brandau1
Jan-Hendrik Gosemann1Hannes Heublein2
Ulrich Herbert Thome3Annett Bläser3Daniel Gräfe4Freerk Prenzel5
Martin Lacher1
Richard Wagner1*- 1Medical Faculty, Department of Pediatric Surgery, Leipzig University, Leipzig, Germany
- 2Medical Faculty, Department of Anesthesiology and Intensive Care, Leipzig University, Leipzig, Germany
- 3Medical Faculty, Department of Neonatology, Leipzig University, Leipzig, Germany
- 4Medical Faculty, Department of Pediatric Radiology, Leipzig University, Leipzig, Germany
- 5Medical Faculty, Department of Pediatrics, Leipzig University, Leipzig, Germany
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Introduction: Tracheoesophageal fistula (TEF) in neonates with esophageal atresia (EA) is conventionally closed by open or thoracoscopic surgery. We present a case of a rare yet potentially life-threatening complication following thoracoscopic ligation of a TEF, using a polymer clip. Case report: A term boy (GA: 42 + 1 weeks; BW: 3110 g) underwent thoracoscopic TEF repair for Type C EA. We ligated the fistula using a polymer clip followed by primary esophageal anastomosis on the second day of life. At ten weeks of age, we readmitted the infant due to recurrent bronchitis and episodes of postprandial coughing. Flexible bronchoscopy revealed that the polymer clip, previously employed for fistula closure, had migrated into the right main bronchus and was subsequently retrieved. Despite clip removal, persistent coughing prompted further evaluation, revealing a recurrent TEF on contrast esophagography. An interdisciplinary team successfully obliterated the recurrent fistula using endoscopic chemocauterization with trichloroacetic acid (TCA) via rigid bronchoscopy. Additionally, due to a developing anastomotic stricture, the patient required four balloon dilations and a single triamcinolone injection. At the three-year follow-up, the patient is eating well and thriving normally. Conclusion: This case underscores the potential complications associated with thoracoscopic TEF closure via clipping. The application of transfixing sutures may offer a more secure and durable closure, reducing the risk of post-surgical complications such as clip migration and fistula recurrence.
Keywords: Esophageal Atresia, Tracheoesophageal Fistula, Thoracoscopy, Clip migration, minimally invasive surgery, case report
Received: 02 Jun 2025; Accepted: 02 Sep 2025.
Copyright: © 2025 Brandau, Gosemann, Heublein, Thome, Bläser, Gräfe, Prenzel, Lacher and Wagner. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Richard Wagner, Medical Faculty, Department of Pediatric Surgery, Leipzig University, Leipzig, Germany
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