A single-patient case report from Zhejiang University School of Medicine Children’s Hospital in Hangzhou, China, describes how a multidisciplinary nursing team supported a 17.5-year-old male patient through endoscopic repair of a recurrent tracheoesophageal fistula, a refractory complication that had persisted since his neonatal surgery for congenital esophageal atresia. The report, published in Frontiers in Pediatrics, focuses not on the surgical technique itself but on the individualized perioperative nursing protocol built around one unusually complex adolescent case.
In this patient, two previous transthoracic attempts to close the fistula had failed, leaving him with persistent choking during feeding, recurrent pneumonia and severe malnutrition, reflected in a body mass index of 15.5 kg/m².
The repair itself used a combined minimally invasive approach pairing suspension laryngoscopy with flexible bronchoscopy, a strategy the authors describe as a novel therapeutic option for this condition. According to the report, conventional nursing routines could not simultaneously manage the compound risks this patient presented, which included severe malnutrition, tracheomalacia, adolescent anxiety and airway edema, and standardized perioperative nursing experience for adolescents with multiple failed open surgeries remains scarce.
To address that gap, the multidisciplinary team implemented four coordinated components before and after the endoscopic procedure: refined airway management, quantitative staged nutrition, whole-course psychological intervention and predictive complication prevention. The airway component was designed around the patient’s tracheomalacia and the risk of airway edema following endoscopic instrumentation, while the nutrition plan was quantified and delivered in stages to rebuild his nutritional status despite the fistula-driven feeding difficulties.
Predictive complication prevention, the fourth element, aimed to anticipate rather than merely react to postoperative problems, particularly those involving the airway and nutrition.
The reported outcomes were favorable within the limits of a single case. No severe complications occurred during hospitalization. Esophagography and bronchoscopy performed on postoperative day 10 confirmed complete fistula healing, and the patient was discharged on postoperative day 14, having gained 0.8 kg during his stay. At one-month follow-up, the authors report sustained fistula closure and continued weight improvement.
The authors conclude that multidisciplinary, individualized perioperative nursing effectively reduced airway and nutritional complications and promoted fistula healing in this adolescent patient undergoing endoscopic minimally invasive repair. They position the case as a replicable, evidence-based nursing reference for similar complex rare esophageal malformation cases, an area where published guidance has been limited.
Several caveats are essential when interpreting these findings. This is a case report of one patient, not a controlled study, so it cannot establish that the nursing protocol caused the outcome or that the same results would generalize to other adolescents with recurrent tracheoesophageal fistulas. The favorable healing confirmed on postoperative day 10 reflects the combined effect of surgery, nursing care and the patient’s individual circumstances, and no comparison group was available. The authors themselves frame the work as a nursing reference rather than a demonstration of efficacy.
Even so, the report documents a meaningful clinical trajectory for a patient who had already endured two failed open fistula closures and arrived with severe malnutrition and recurrent pneumonia. The detailed description of staged nutrition targets, airway precautions and whole-course psychological support offers concrete operational detail that other pediatric surgical and nursing teams may adapt when caring for comparable adolescents, a population the authors identify as underserved by existing standardized protocols.
Subject of Research: Multidisciplinary perioperative nursing for an adolescent undergoing endoscopic repair of recurrent tracheoesophageal fistula after congenital esophageal atresia repair.
Article Title: Perioperative individualized nursing for an adolescent with recurrent tracheoesophageal fistula after endoscopic repair: a case report
Article References: Xia, M., Tan, Z., Liu, J., Wu, L., Zhao, H., & Xia, J. (2026). Perioperative individualized nursing for an adolescent with recurrent tracheoesophageal fistula after endoscopic repair: a case report. Frontiers in Pediatrics, 14, Article 1958428. https://doi.org/10.3389/fped.2026.1958428
Image Credits: AI Generated
DOI: 10.3389/fped.2026.1958428
Keywords: recurrent tracheoesophageal fistula, congenital esophageal atresia, perioperative nursing, multidisciplinary team, endoscopic repair, suspension laryngoscopy, flexible bronchoscopy, pediatric surgery, malnutrition, case report, adolescent health, airway management
News Source: Ophelia Keating. (October 29, 2026). Individualized Perioperative Nursing Helped an Adolescent Heal After Recurrent Fistula Repair. Scienmag.
