Tracheoesophageal fistula (TEF) most commonly occurs as which type in the Gross classification?

• A Type A — esophageal atresia without fistula
• B Type E — H-type fistula without esophageal atresia
• C Type B — proximal esophageal atresia with proximal TEF
• D Type C — proximal esophageal atresia with distal TEF ✓

Explanation

In the Gross classification of esophageal atresia and TEF, Type C (proximal esophageal atresia with distal tracheoesophageal fistula) accounts for approximately 85–87% of all TEF cases. The distal esophageal segment communicates with the trachea, causing gaseous distension of the stomach. The clinical triad is: excess salivation/drooling, choking on first feed, and gastric distension on X-ray. Diagnosis is confirmed by inability to pass a nasogastric tube beyond 10–12 cm. Type E (H-fistula) is the second rarest but often missed due to absence of atresia.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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