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Walker B, Axtell AL. Management of Tracheoesophageal Fistula and Tracheoinnominate Fistula. Thorac Surg Clin 2025; 35:73-81. [PMID: 39515897 DOI: 10.1016/j.thorsurg.2024.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2024]
Abstract
Fistulization between the tracheobronchial tree and gastrointestinal tract is a challenging clinical situation that leads to life-threatening pulmonary contamination and inadequate nutrition. Operative management requires repair of both airway and esophageal defects with or without tracheal resection and reconstruction to restore a functional airway and maintain gastrointestinal continuity. Tracheoinnominate fistula is a rare communication between the airway and innominate artery that can result in fatal hemorrhage. Prompt operative intervention is lifesaving and can be performed by division of the innominate artery and interposition of a vascularized tissue flap between the trachea and divided artery.
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Affiliation(s)
- Brittany Walker
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA
| | - Andrea L Axtell
- Division of Cardiothoracic Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, H4/318, Madison, WI 53792, USA.
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2
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Jesani H, Hundle A, Nankivell P, Kalkat M. The long lost denture: a rare case of an acquired, non-malignant tracheo-oesophageal fistula. J Cardiothorac Surg 2024; 19:621. [PMID: 39497187 PMCID: PMC11533386 DOI: 10.1186/s13019-024-03073-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2024] [Accepted: 09/15/2024] [Indexed: 11/07/2024] Open
Abstract
BACKGROUND Ingested dental prosthesis are susceptible to impaction in the gastrointestinal tract due to their sharp edges, size and contour. Delays in presentation arise from the lack of clear history of ingestion and misdiagnosis occurs due to the radiolucency of denture material on plain radiography. An acquired, non-malignant tracheo-oesophageal fistula (TOF) may develop from a chronically impacted denture. Surgical management of a TOF secondary to denture is a challenging clinical problem that is rarely reported in the literature and no previous case reports have described the two-staged reconstruction approach that we present here. CASE PRESENTATION We report a case of a male in his early 60s who presented to an acute general hospital with symptoms ongoing for over one year of dysphagia, recurrent chest infections and weight loss. Barium swallow and computed tomography identified an ingested dental prosthesis (denture) that had caused a TOF. He was transferred to our specialist thoracic surgery unit where an attempt to remove the foreign body endoscopically was abandoned due to firm impaction and risk of further injury. The subsequent multi-disciplinary management of this complex case required a two-staged reconstruction approach. The first procedure involved extracting the foreign body, repairing the underlying defects with tracheal resection and anastomosis, and creating an oesophageal diversion with cervical oesophagostomy. The second procedure achieved continuity of the gastrointestinal tract with gastric pull-up and pharyngo-gastric anastomosis. Following rehabilitation, the patient was discharged on oral intake alongside percutaneous jejunostomy feeding. CONCLUSIONS Early recognition and removal of impacted dental prosthesis is essential to prevent morbidity and mortality. Delayed diagnosis can lead to acquired TOF with associated consequences such as recurrent pulmonary infection, mediastinitis and nutritional deficit. Challenges we encountered, such as failed attempts at endoscopic retrieval and the difficult dissection of fibrotic tissue, were directly due to the delayed identification of the denture. We highlight the importance of holding a high index of clinical suspicion of foreign body ingestion in dental prosthesis wearers who present with recurrent chest infections and ongoing dysphagia. We also promote the need for a collaborative multi-disciplinary approach in the surgical management of complex cases.
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Affiliation(s)
- Hannah Jesani
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
| | - Aaron Hundle
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul Nankivell
- Department of Otolaryngology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- University of Birmingham, Institute of Cancer and Genomic Sciences, Institute of Head and Neck Studies and Education (InHANSE), Birmingham, UK
| | - Maninder Kalkat
- Department of Thoracic Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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3
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Koch KE, Dhanasopon AP, Woodard GA. Airway Esophageal Fistula. Thorac Surg Clin 2024; 34:405-414. [PMID: 39332865 DOI: 10.1016/j.thorsurg.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2024]
Abstract
Acquired tracheoesophageal fistulas (TEFs) are rare pathologic connections between the trachea and esophagus. Esophageal and tracheal stenting have been increasingly and safely utilized in management of TEFs, but surgical repair remains the most definitive treatment. Surgical approach to treating TEFs depends on its location, but principles include division and closure of the fistula tracts and insertion of a muscle flap in between the repairs to buttress and prevent recurrence. Advances in diagnostic tools, endoscopic and surgical methods, and intensive care have led to significantly improved outcomes in the management of acquired TEFs.
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Affiliation(s)
- Kelsey E Koch
- Division of Thoracic Surgery, Yale School of Medicine, 330 Cedar Street, BB205, New Haven, CT 06520, USA
| | - Andrew P Dhanasopon
- Division of Thoracic Surgery, Yale School of Medicine, 330 Cedar Street, BB205, New Haven, CT 06520, USA
| | - Gavitt A Woodard
- Division of Thoracic Surgery, Yale School of Medicine, 330 Cedar Street, BB205, New Haven, CT 06520, USA.
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Fu M, Wang D, Wang J, Xu Q, Cao L, Zhang J. Closure of a secondary tracheoesophageal fistula in severe pneumonia using an Amplatzer Duct Occluder II during invasive mechanical ventilation: A case report. Clin Case Rep 2024; 12:e9470. [PMID: 39421527 PMCID: PMC11483531 DOI: 10.1002/ccr3.9470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/29/2024] [Accepted: 09/21/2024] [Indexed: 10/19/2024] Open
Abstract
Key Clinical Message Early and timely closure of secondary tracheoesophageal fistula (TEF) is crucial for critically ill patients. For those requiring invasive mechanical ventilation, the Amplatzer Duct Occluder II (ADO II) can be used as an emergency therapeutic option to rapidly close secondary TEF, providing opportunities for subsequent treatments. Abstract Secondary tracheoesophageal fistula (TEF) is a life-threatening condition characterized by high mortality, high recurrence rates, and multiple complications. Reports on the management of secondary TEF in critically ill patients are limited due to the challenges in treatment and the lack of suitable therapeutic options. We report a case of secondary TEF in a 69-year-old male diagnosed with severe pneumonia, whose condition deteriorated rapidly following the onset of TEF. Despite invasive mechanical ventilation, maintaining blood oxygen saturation above 80% was unachievable due to the TEF. Bedside bronchoscopy revealed expansion TEF expansion caused by gastrointestinal fluid reflux and respiratory machine pressure. The TEF was urgently closed using an ADO II device during invasive mechanical ventilation to prevent further deterioration. After the patient's condition stabilized, the ADO II was replaced with a Y-shaped tracheal membrane-covered stent for further TEF management. The patient's condition improved, meeting the criteria for liberation from invasive mechanical ventilation, and bedside chest X-rays revealed a gradual resolution of pulmonary inflammation. Selecting appropriate treatment modalities for early and timely closure of secondary TEF is crucial for critically ill patients. ADO II can serve as a rescue therapy to achieve rapid closure of secondary TEF in critically ill patients requiring invasive mechanical ventilation support, providing opportunities and time for subsequent treatment.
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Affiliation(s)
- Meng Fu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of China (USTC)HefeiAnhuiChina
- Science Island Branch, Graduate School of USTCUniversity of Science and Technology of China (USTC)HefeiAnhuiChina
- Anhui Province Key Laboratory of Medical Physics and Technology, Institute of Health and Medical Technology, Hefei Institutes of Physical ScienceChinese Academy of SciencesHefeiAnhuiChina
| | - Dongsheng Wang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of China (USTC)HefeiAnhuiChina
| | - Jialiang Wang
- Institute of Molecular Enzymology, School of Biology & Basic Medical SciencesSuzhou Medical College of Soochow UniversitySuzhouJiangsuChina
| | - Qixia Xu
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of China (USTC)HefeiAnhuiChina
| | - Lejie Cao
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of China (USTC)HefeiAnhuiChina
| | - Junqiang Zhang
- Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and MedicineUniversity of Science and Technology of China (USTC)HefeiAnhuiChina
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5
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Cohen WG, Chalian A, Brody RM. Flap-based Closure of Acquired Tracheoesophageal Fistulas. Laryngoscope 2024; 134:3761-3764. [PMID: 38466164 DOI: 10.1002/lary.31386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/08/2024] [Accepted: 02/26/2024] [Indexed: 03/12/2024]
Abstract
Iatrogenic tracheoesophageal fistulae management and repair are difficult to manage with few resourced describing management and repair. Two cases are presented describing the approach to and repair of a tracheoesophagea fistula; one with a free flap and one with local flap reconstruction. Both cases utilized allograft material to maintain separation between the alimentary and repiratory tracts. Laryngoscope, 134:3761-3764, 2024.
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Affiliation(s)
- William G Cohen
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Ara Chalian
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
| | - Robert M Brody
- Department of Otorhinolaryngology - Head & Neck Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, U.S.A
- Veterans Affairs Medical Center, Philadelphia, Pennsylvania, U.S.A
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Perraudin T, Benkiran T, Alcaraz F, Camuzard O, Berthet JP, Lupon E. Internal mammary artery perforator flap for repair of an upper thoracic tracheo-oesophageal fistula. ANN CHIR PLAST ESTH 2024; 69:326-330. [PMID: 38866678 DOI: 10.1016/j.anplas.2024.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/15/2024] [Accepted: 05/23/2024] [Indexed: 06/14/2024]
Abstract
Tracheoesophageal fistulas (TOF) following esophagectomy for esophageal cancer are rare but potentially fatal. There is no consensus on treatment between stenting and surgical repair, although the latter is associated with better distant survival. In surgical repair, the interposition of a flap improves healing by providing well-vascularized tissue and reinforcing the repair zone. The flaps described are usually muscular and decaying. We present the case of a malnourished fifty-year-old man who underwent intrathoracic surgical repair of symptomatic recurrent TOF using a skin flap based on the perforators of the internal thoracic artery (IMAP). The perforator flap was completely de-epidermized and tunneled under the sternum by a proximal and limited resection of the 3rd costal cartilage and placed at the posterior aspect of the trachea, with the excess tissue rolled up on either side. At 9 months, the patient showed no recurrence and improved general condition. The de-epidermized IMAP tunneled under the sternum intrathoracically is a reliable alternative to the conventional muscle flaps described in TOF management and an attractive additional tool in the plastic surgeon's surgical arsenal.
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Affiliation(s)
- T Perraudin
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, Nice, France
| | - T Benkiran
- Department of Thoracic Surgery, CHU de Nice, Nice, France
| | - F Alcaraz
- Department of Thoracic Surgery, CHU de Nice, Nice, France
| | - O Camuzard
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, Nice, France
| | - J P Berthet
- Department of Thoracic Surgery, CHU de Nice, Nice, France
| | - E Lupon
- Department of Plastic and Reconstructive Surgery, Institut Universitaire Locomoteur et du Sport, Pasteur 2 Hospital, University Côte d'Azur, Nice, France.
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Cui J, Wang Y, Li S, Le Y, Deng Y, Chen J, Peng Q, Xu R, Li J. Efficacy of mesenchymal stem cells in treating tracheoesophageal fistula via the TLR4/NF-κb pathway in beagle macrophages. Heliyon 2024; 10:e32903. [PMID: 39021940 PMCID: PMC11253233 DOI: 10.1016/j.heliyon.2024.e32903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 06/11/2024] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Background Tracheoesophageal fistula (TEF) remains a rare but significant clinical challenge, mainly due to the absence of established, effective treatment approaches. The current focus of therapeutic strategy is mainly on fistula closure. However, this approach often misses important factors, such as accelerating fistula contraction and fostering healing processes, which significantly increases the risk of disease recurrence. Methods In order to investigate if Mesenchymal Stem Cells (MSCs) can enhance fistula repair, developed a TEF model in beagles. Dynamic changes in fistula diameter were monitored by endoscopy. Concurrently, we created a model of LPS-induced macrophage to replicate the inflammatory milieu typical in TEF. In addition, the effect of MSC supernatant on inflammation mitigation was evaluated. Furthermore, we looked at the role of TLR4/NF-κB pathway plays in the healing process. Results Our research revealed that the local administration of MSCs significantly accelerated the fistula's healing process. This was demonstrated by a decline in TEF apoptosis and decrease in the production of pro-inflammatory cytokines. Furthermore, in vivo experiments demonstrated that the MSC supernatant was effective in suppressing pro-inflammatory cytokine expression and alleviating apoptosis in LPS-induced macrophages. These therapeutic effects were mainly caused by the suppression of TLR4/NF-κB pathway. Conclusion According to this study, MSCs can significantly improve TEF recovery. They achieve this via modulating apoptosis and inflammatory responses, mainly by selectively inhibiting the TLR4/NF-κB pathway.
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Affiliation(s)
- Jinghua Cui
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, 510080, China
| | - Yuchao Wang
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, 510080, China
- School of Medicine South China University of Technology, Guangzhou, 510006, China
| | - Shuixiu Li
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, 510080, China
- The Second School of Clinical Medicine, Southern Medical University. Guangzhou, Guangdong, 51006, China
| | - Yanqing Le
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, 510080, China
| | - Yi Deng
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, 510080, China
- Medical School, Kunming University of Science and Technology, Department of Pulmonary and Critical Care Medicine, The First People’s Hospital of Yunnan Province Kunming, Yunnan, China. 650000
| | - Jingjing Chen
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, 510080, China
| | - Qian Peng
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, 510080, China
| | - Rongde Xu
- Department of Interventional Radiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou Guangdong, China, 510080
| | - Jing Li
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University. Guangzhou, Guangdong, 510080, China
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Vanstraelen S, Vos R, Dausy M, Van Slambrouck J, Vanluyten C, De Leyn P, Coosemans W, Decaluwé H, Van Veer H, Depypere L, Bisschops R, Demedts I, Casaer MP, Debaveye Y, De Vlieger G, Godinas L, Verleden G, Van Raemdonck D, Nafteux P, Ceulemans LJ. Diagnosis and Management of Esophageal Fistulas After Lung Transplantation: A Case Series. Transplant Direct 2024; 10:e1593. [PMID: 38414977 PMCID: PMC10898668 DOI: 10.1097/txd.0000000000001593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 12/05/2023] [Accepted: 12/31/2023] [Indexed: 02/29/2024] Open
Abstract
Background Lung transplantations are highly complex procedures, often conducted in frail patients. Through the addition of immunosuppressants, healing can be compromised, primarily leading to the development of bronchopleural fistulas. Although esophageal fistulas (EFs) after lung transplantation remain rare, they are associated with significant morbidity. We aimed to investigate the clinical presentation, diagnostic approaches, and treatment strategies of EF after lung transplantation. Methods All patients who developed EF after lung transplantation at the University Hospitals Leuven between January 2019 and March 2022 were retrospectively reviewed and the clinical presentations, diagnostic approaches, and treatment strategies were summarized. Results Among 212 lung transplantation patients, 5 patients (2.4%) developed EF. Three patients were male and median age was 39 y (range, 34-63). Intraoperative circulatory support was required in 3 patients, with 2 needing continued support postoperatively. Bipolar energy devices were consistently used for mediastinal hemostasis. All EFs were right-sided. Median time to diagnosis was 28 d (range, 12-48) and 80% of EFs presented as recurrent respiratory infections or empyema. Diagnosis was made through computed tomography (n = 3) or esophagogastroscopy (n = 2). Surgical repair with muscle flap covering achieved an 80% success rate. All patients achieved complete resolution, with only 1 patient experiencing a fatal outcome during a complicated EF-related recovery. Conclusion Although EF after lung transplantation remains rare, vigilance is crucial, particularly in cases of right-sided intrathoracic infection. Moreover, caution must be exercised when applying thermal energy in the mediastinal area to prevent EF development and mitigate the risk of major morbidity. Timely diagnosis and surgical intervention can yield favorable outcomes.
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Affiliation(s)
- Stijn Vanstraelen
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Robin Vos
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Marie Dausy
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Jan Van Slambrouck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Cedric Vanluyten
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Paul De Leyn
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Willy Coosemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Herbert Decaluwé
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Hans Van Veer
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Lieven Depypere
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Raf Bisschops
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Translational research of gastrointestinal diseases (TARGID), KU Leuven, Leuven, Belgium
| | - Ingrid Demedts
- Department of Gastroenterology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Translational research of gastrointestinal diseases (TARGID), KU Leuven, Leuven, Belgium
| | - Michael P. Casaer
- Department of Intensive Care, University Hospitals Leuven, Leuven, Belgium
- Department of Cellular and Molecular Medicine, Laboratory of Intensive Medicine, KU Leuven, Leuven, Belgium
| | - Yves Debaveye
- Department of Intensive Care, University Hospitals Leuven, Leuven, Belgium
- Department of Cellular and Molecular Medicine, Laboratory of Intensive Medicine, KU Leuven, Leuven, Belgium
| | - Greet De Vlieger
- Department of Intensive Care, University Hospitals Leuven, Leuven, Belgium
- Department of Cellular and Molecular Medicine, Laboratory of Intensive Medicine, KU Leuven, Leuven, Belgium
| | - Laurent Godinas
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Geert Verleden
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Philippe Nafteux
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
| | - Laurens J. Ceulemans
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery (BREATHE), KU Leuven, Leuven, Belgium
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Bertrand T, Mercier O, Leymarie N, Issard J, Honart JF, Fabre D, Kolb F, Fadel E. Surgical cervicothoracic-flap repair of neoesophagus-airway fistula after esophagectomy for esophageal cancer: A retrospective cohort study. JTCVS Tech 2024; 23:123-131. [PMID: 38351987 PMCID: PMC10859646 DOI: 10.1016/j.xjtc.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/29/2023] [Accepted: 10/30/2023] [Indexed: 02/16/2024] Open
Abstract
Objective To evaluate outcomes of surgical repair of postesophagectomy neoesophagus-airway fistulas (NEAFs). Methods We retrospectively included consecutive patients with NEAF managed by various techniques at our center between August 2009 and July 2021. Result Of the 11 patients (median age, 60 years; interquartile range, 58, 62), 4 had received induction chemoradiotherapy and 4 others induction chemotherapy. NEAF was mainly a complication of anastomotic leakage (n = 6) or attempted stenosis treatment (n = 3). The airway mainly involved was the trachea (n = 8). Airway defects were repaired by resection-anastomosis (n = 5), perforator flaps (n = 4), pedicled pericardium (n = 1), and/or direct suturing (n = 2). Gastric conduit defects were repaired by perforator flaps (n = 6), direct suturing (n = 2), or pedicled pericardium (n = 1). Of the 7 perforator flaps, 4 were internal mammary-artery, two dorsal intercostal-artery, and one supraclavicular-artery flaps. After a median follow-up of 100 months, 2 patients died on early postoperative course from NEAF repair failure and 3 from late NEAF recurrence at 4, 11, and 33 months. Among the remaining 6 patients, 1 died from local tumoral recurrence at 13 months, 1 was last on follow-up at 27 months, alive and eating normally. The other 4 were free from NEAF recurrence and dysphagia or swallowing disorder at 50 months' follow-up. These 4 results were obtained thanks to perforator flap interposition and airway resection anastomosis. Conclusions Surgical NEAF repair using perforator flap interposition may provide satisfactory long-term function after strong prehabilitation.
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Affiliation(s)
- Thibaud Bertrand
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Olaf Mercier
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Nicolas Leymarie
- Department of Reconstructive Surgery, Gustave Roussy, Villejuif, France
| | - Justin Issard
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | | | - Dominique Fabre
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
| | - Frédéric Kolb
- Department of Reconstructive Surgery, University of California, San Diego, San Diego, Calif
| | - Elie Fadel
- Department of Thoracic Surgery and Heart-Lung Transplantation, Université Paris-Saclay, Marie-Lannelongue Hospital, GHPSJ, Le Plessis Robinson, France
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10
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Zeng A, Liu X, Shaik MS, Jiang G, Dai J. Surgical strategies for benign acquired tracheoesophageal fistula. Eur J Cardiothorac Surg 2024; 65:ezae047. [PMID: 38341657 DOI: 10.1093/ejcts/ezae047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/14/2023] [Accepted: 02/08/2024] [Indexed: 02/12/2024] Open
Abstract
OBJECTIVES Tracheoesophageal fistula (TEF) is characterized by abnormal connectivity between the posterior wall of the trachea or bronchus and the adjacent anterior wall of the oesophagus. Benign TEF can result in serious complications; however, there is currently no uniform standard to determine the appropriate surgical approach for repairing TEF. METHODS The PubMed database was used to search English literature associated with TEF from 1975 to October 2023. We employed Boolean operators and relevant keywords: 'tracheoesophageal fistula', 'tracheal resection', 'fistula suture', 'fistula repair', 'fistula closure', 'flap', 'patch', 'bioabsorbable material', 'bioprosthetic material', 'acellular dermal matrix', 'AlloDerm', 'double patch', 'oesophageal exclusion', 'oesophageal diversion' to search literature. The evidence level of the literature was assessed based on the GRADE classification. RESULTS Nutritional support, no severe pulmonary infection and weaning from mechanical ventilation were the 3 determinants for timing of operation. TEFs were classified into 3 levels: small TEF (<1 cm), moderate TEF (≥1 but <5 cm) and large TEF (≥5 cm). Fistula repair or tracheal segmental resection was used for the small TEF with normal tracheal status. If the anastomosis cannot be finished directly after tracheal segmental resection, special types of tracheal resection, such as slide tracheoplasty, oblique resection and reconstruction, and autologous tissue flaps were preferred depending upon the site and size of the fistula. Oesophageal exclusion was applicable to refractory TEF or patients with poor conditions. CONCLUSIONS The review primarily summarizes the main surgical techniques employed to repair various acquired TEF, to provide references that may contribute to the treatment of TEF.
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Affiliation(s)
- Ao Zeng
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Xiaogang Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | | | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jie Dai
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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11
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de Groot EM, Kingma BF, Goense L, van der Kaaij NP, Meijer RCA, Ramjankhan FZ, Schellekens PAA, Braithwaite SA, Marsman M, van der Heijden JJ, Ruurda JP, van Hillegersberg R. Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy. Dis Esophagus 2024; 37:doad054. [PMID: 37592909 PMCID: PMC10762505 DOI: 10.1093/dote/doad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 08/19/2023]
Abstract
The aim of this study was to evaluate the surgical treatment of esophago-tracheobronchial fistulas (ETBFs) that occurred after esophagectomy with gastric conduit reconstruction in a tertiary referral center for esophageal surgery. All patients who underwent surgical repair for an ETBF after esophagectomy with gastric conduit reconstruction were included in a tertiary referral center. The primary outcome was successful recovery after surgical treatment for ETBF, defined as a patent airway at 90 days after the surgical fistula repair. Secondary outcomes were details on the clinical presentation, diagnostics, and postoperative course after fistula repair. Between 2007 and 2022, 14 patients who underwent surgical repair for an ETBF were included. Out of 14 patients, 9 had undergone esophagectomy with cervical anastomosis and 5 esophagectomy with intrathoracic anastomosis after which 13 patients had developed anastomotic leakage. Surgical treatment consisted of thoracotomy to cover the defect with a pericardial patch and intercostal flap in 11 patients, a patch without interposition of healthy tissue in 1 patient, and fistula repair via cervical incision with only a pectoral muscle flap in 2 patients. After surgical treatment, 12 patients recovered (86%). Mortality occurred in two patients (14%) due to multiple organ failure. This study evaluated the techniques and outcomes of surgical repair of ETBFs following esophagectomy with gastric conduit reconstruction in 14 patients. Treatment was successful in 12 patients (86%) and generally consisted of thoracotomy and coverage of the defect with a bovine pericardial patch followed by interposition with an intercostal muscle.
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Affiliation(s)
- E M de Groot
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - B F Kingma
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Goense
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N P van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R C A Meijer
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - F Z Ramjankhan
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P A A Schellekens
- Department of Plastic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S A Braithwaite
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - M Marsman
- Department of Anesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J van der Heijden
- Department of Intensive Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J P Ruurda
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - R van Hillegersberg
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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12
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Amore D, Rispoli M, Caterino U, Casazza D, Imitazione P, Saglia A, Cesaro C. Comments on "The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient". Monaldi Arch Chest Dis 2023; 94. [PMID: 37781758 DOI: 10.4081/monaldi.2023.2731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023] Open
Abstract
Dear Editor, We have read with interest the case reported by Rotolo et al. (published in February 2023) concerning the surgical management of tracheoesophageal fistula in a COVID-19 patient treated with prolonged mechanical ventilation for severe respiratory failure...
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Affiliation(s)
- Dario Amore
- Department of Thoracic Surgery, Monaldi Hospital, Naples
| | - Marco Rispoli
- Department of Anesthesia and Intensive Care, Monaldi Hospital, Naples
| | | | - Dino Casazza
- Department of Thoracic Surgery, Monaldi Hospital, Naples
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13
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Engel-Rodriguez A, Tiru-Vega M, Merced-Roman J, Fonseca-Ferrer V, Engel-Rodriguez N, Otero-Dominguez Y, Rodriguez-Cintron W. Diagnosis and Management of a Massive Eight-Centimeter Acquired Tracheoesophageal Fistula. Cureus 2023; 15:e43689. [PMID: 37724200 PMCID: PMC10505277 DOI: 10.7759/cureus.43689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/20/2023] Open
Abstract
Here, we present the case of a 61-year-old veteran Hispanic male with recurrent aspiration pneumonitis, aerophagia, tympanic abdominal bloating, and a positive Ono's sign; symptoms present were secondary to diagnosed tracheoesophageal fistulas (TEFs). TEFs are abnormal connections between the esophagus and the trachea. In adult cases, several risk factors have been identified for acquired cases, which include infection, trauma, and cancer. Diagnosis of TEF can be challenging and, in most cases, requires high suspicion. Currently, there are no established guidelines for diagnosing and managing TEF. Clinical assessment and various imaging techniques are essential in the diagnostic process. This article will discuss the etiology, clinical presentation, diagnostic approaches, and management options for acquired TEFs.
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Affiliation(s)
| | - Marilee Tiru-Vega
- Internal Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - Jesus Merced-Roman
- Internal Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - Vanessa Fonseca-Ferrer
- Pulmonology and Critical Care, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | | | - Yomayra Otero-Dominguez
- Pulmonary and Critical Care Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
| | - William Rodriguez-Cintron
- Pulmonary and Critical Care Medicine, Veterans Affairs (VA) Caribbean Healthcare Systems, San Juan, PRI
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14
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Dessard L, Deflandre J, Deflandre J, Moonen V, Delhougne N, Goffart Y. First-time use of a porcine small intestine submucosal plug device to close an acquired tracheo-esophageal fistula. Surg Case Rep 2023; 9:101. [PMID: 37294363 DOI: 10.1186/s40792-023-01670-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 05/12/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Acquired tracheo-esophageal fistula (TEF) is a rare, life-threatening pathology, responsible for severe comorbidities. Its management is a real therapeutic challenge and remains controversial. CASE PRESENTATION We report the first case of endoscopic treatment of TEF by using a porcine small intestine submucosal (SIS) plug device in a young quadriplegic patient after failed surgical closure by cervicotomy. After 1 year of follow-up, oral feeding of the patient was resumed and no clinical signs of fistula recurrence were evident. CONCLUSION To our knowledge, we obtained for the first time, a satisfactory result for TEF closure with the use of a porcine SIS plug.
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Affiliation(s)
- Laura Dessard
- Department of Otorhinolaryngology, Citadelle Hospital, Liège, Belgium.
| | | | | | - Vincent Moonen
- Department of Otorhinolaryngology, Citadelle Hospital, Liège, Belgium
| | | | - Yves Goffart
- Department of Otorhinolaryngology, Citadelle Hospital, Liège, Belgium
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15
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Koike T, Hosoda Y, Nakamura M, Shimizu Y, Goto T, Mizuno KI, Tsuchida M. Bronchoesophageal Fistula After Systematic Mediastinal Lymph Node Dissection With Pulmonary Lobectomy. ANNALS OF THORACIC SURGERY SHORT REPORTS 2023; 1:124-127. [PMID: 39790497 PMCID: PMC11708611 DOI: 10.1016/j.atssr.2022.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/26/2022] [Indexed: 01/12/2025]
Abstract
We present a case of a bronchoesophageal fistula after a lobectomy with systematic mediastinal lymphadenectomy for lung adenocarcinoma. A 70-year-old woman was readmitted with postprandial cough, fever, and dysphagia on postoperative day 13. Computed tomography revealed a bronchoesophageal fistula between the left main bronchus and esophagus. Esophagogastroscopy revealed a 3-mm fistula 30 cm from the incisors. Two rounds of endoscopic closure with metal clips were performed. The patient has survived for 24 months with no evidence of recurrent fistula. Although postoperative ischemic bronchitis after mediastinal lymphadenectomy may cause bronchoesophageal fistulas, they can be treated with endoscopic closure.
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Affiliation(s)
- Terumoto Koike
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuta Hosoda
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masaya Nakamura
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Yuki Shimizu
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Tatsuya Goto
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Ken-Ichi Mizuno
- Division of Gastroenterology and Hepatology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Masanori Tsuchida
- Division of Thoracic and Cardiovascular Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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16
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Post-esophagectomy tracheobronchoesophageal fistula: management and results of a tertiary referral center. Updates Surg 2023; 75:435-449. [PMID: 35996059 DOI: 10.1007/s13304-022-01364-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF after esophagectomy and compare it with other reported series. Patients who developed a TBEF after esophagectomy were identified retrospectively. Baseline and intraoperative characteristics, postoperative and TBEF details, treatments for TBEF, and main outcomes are described. A univariate analysis was performed to compare some of the analyzed variables with the overall sample. Finally, our results are compared with the previously described series. Altogether, 16 patients with TBEF (3.11%) were analyzed from 514 patients who received esophagectomies between January 2014 and February 2020. As a first treatment attempt, 14 (87.5%) were treated with surgery, one was treated conservatively, and one was treated endoscopically. Surgery both at a first or second treatment attempt achieved a survival rate of 62.5% and oral intake at discharge of 43.75%. Six patients died during their hospital stay (37.5%). The presence of an anastomotic leak showed a strong association with TBEF development (100% vs. 19.7%; OR 1.163, 95% CI 1.080-1.253, p = 0.000). In our experience, surgical treatment as the first approach for TBEF associated with anastomotic leak after esophagectomy obtained good results. However, there is an urgent need to elaborate treatment guidelines based on international consensus.
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17
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Li L, Wang Y, Zhu C, Wei J, Zhang W, Sang H, Chen H, Qian H, Xu M, Liu J, Jin S, Jin Y, Zha W, Song W, Zhu Y, Wang J, Lo SK, Zhang G. Endoscopic closure of refractory upper GI-tracheobronchial fistulas with a novel occluder: a prospective, single-arm, single-center study (with video). Gastrointest Endosc 2022; 97:859-870.e5. [PMID: 36572125 DOI: 10.1016/j.gie.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/19/2022] [Accepted: 12/18/2022] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Upper GI-tracheobronchial fistula is a morbid condition with high mortality. It is a challenge for endoscopists because currently available treatments have severe limitations. In this study we assessed the efficacy and safety of an occluder we invented for endoscopic closure of refractory upper GI-tracheobronchial fistulas. METHODS This was a prospective, single-arm, single-center trial conducted between September 2020 and March 2022. All patients undergoing occluder placement were eligible to enroll. The primary endpoints were clinical success rate (CSR) and complete closure rate (CCR) at 3 months and safety. Secondary efficacy endpoints were technical success rates, CSRs and CCRs at 1 and 6 months, near-complete closure rates, change from baseline in body mass index (BMI), and health-related quality of life (HRQoL) at 1, 3, and 6 months. RESULTS Twenty-eight patients (mean age, 63.2 years; 23 men) were enrolled. Eighteen through-the-scope occluders (TTSOs) and 10 through-the-overtube occluders (TTOOs) were implanted, with a technical success rate of 100%. The mean procedure time for the TTSO and TTOO groups were 28.0 ± 8.0 minutes and 31.8 ± 7.7 minutes, respectively. The CSRs at 1, 3, and 6 months were 92.9%, 96.4%, and 92.0% and the CCRs were 60.7%, 60.7%, and 60.0%, respectively. The mean BMI at 3 and 6 months and HRQoL at 1, 3, and 6 months were significantly increased compared with baseline (P < .05). Two completely occluded fistulas had 1-sided or complete healing by coverage of granulation tissue and re-epithelialized mucosa at a follow-up of 6 and 12 months. All 14 adverse events were either mild and transient or easily corrected. CONCLUSIONS Our clinical outcomes suggest that this novel GI occluder is a safe and effective salvage option for patients with refractory upper GI-tracheobronchial fistulas. (Clinical trial registration number: ChiCTR2000038566.).
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Affiliation(s)
- Lurong Li
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yun Wang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chang Zhu
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jianyu Wei
- Department of Translational Medicine, Micro-Tech Co, Ltd, Nanjing, China
| | - Weifeng Zhang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huaiming Sang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Han Chen
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Haisheng Qian
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Miao Xu
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiahao Liu
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shuxian Jin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yu Jin
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wangjian Zha
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wei Song
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Zhu
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jiwang Wang
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Simon K Lo
- Karsh Division of Gastroenterology and Hepatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Guoxin Zhang
- Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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18
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Chandra TS, Sadhana O, Sameera G, Murthy PSN, Dimple A. Management of Cervical Tracheo-Esophageal Fistula by Lateral Cervical Approach: Our Experience'. Indian J Otolaryngol Head Neck Surg 2022; 74:6039-6044. [PMID: 36742898 PMCID: PMC9895662 DOI: 10.1007/s12070-021-02682-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/09/2021] [Indexed: 02/07/2023] Open
Abstract
Acquired Tracheo-esophageal fistula (TEF) is a challenging and complicated condition. The laryngeal protection is lost in acquired TEF cases due to the established connection between the esophagus and the airways leading to aspiration, pneumonia, and acute respiratory distress syndrome. Malignancy contributes to about 80% of acquired TEF. Nonmalignant causes for TEF include prolonged ventilation, trauma (iatrogenic, penetrating, or blunt injury), foreign bodies, corrosive burns, and granulomatous infections. With the advancements in critical care, the incidence of TEF post-ventilation is on the rise in recent decades. We would like to share our experience managing ten cases of nonmalignant acquired cervical TEF by the lateral cervical approach at our institute. Apart from the isolated TEF cases, one patient with concomitant tracheal stenosis was repaired simultaneously with good postoperative results. TEF was identified in two cases following removal of T-tube and solid stent respectively and was repaired successfully with lateral cervical approach with strap muscle flap interposition.
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Affiliation(s)
- T. Satish Chandra
- Department of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation (PSIMS and RF), Chinnautapalli, Gannavaram, Andhrapradesh India
| | - O. Sadhana
- Department of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation (PSIMS and RF), Chinnautapalli, Gannavaram, Andhrapradesh India
| | - G. Sameera
- Department of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation (PSIMS and RF), Chinnautapalli, Gannavaram, Andhrapradesh India
| | - P. S. N. Murthy
- Department of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation (PSIMS and RF), Chinnautapalli, Gannavaram, Andhrapradesh India
| | - A. Dimple
- Department of ENT, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation (PSIMS and RF), Chinnautapalli, Gannavaram, Andhrapradesh India
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19
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Gomez Zuleta MA, Gallego Ospina DM, Ruiz OF. Tracheoesophageal fistulas in coronavirus disease 2019 pandemic: A case report. World J Gastrointest Endosc 2022; 14:628-635. [PMID: 36303807 PMCID: PMC9593510 DOI: 10.4253/wjge.v14.i10.628] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 07/13/2022] [Accepted: 09/14/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Tracheoesophageal fistulas (TEFs) can be described as a pathological communication between the trachea and the esophagus. According to their origin, they may be classified as benign or malignant. Benign TEFs occur mostly as a consequence of prolonged mechanical ventilation, particularly among patients exposed to endotracheal cuff overinflation. During the severe acute respiratory syndrome coronavirus 2 virus pandemic, the amount of patients requiring prolonged ventilation rose, which in turn increased the incidence of TEFs.
CASE SUMMARY We report the cases of 14 patients with different comorbidities such as being overweight, or having been diagnosed with diabetes mellitus or systemic hypertension. The most common symptoms on arrival were dyspnea and cough. In all cases, the diagnosis of TEFs was made through upper endoscopy. Depending on the location and size of each fistula, either endoscopic or surgical treatment was provided. Eight patients were treated endoscopically. Successful closure of the defect was achieved through over the scope clips in two patients, while three of them required endoscopic metal stenting. A hemoclip was used to successfully treat one patient, and it was used temporarily for another patient pended surgery. Surgical treatment was performed in patients with failed endoscopic management, leading to successful defect correction. Two patients died before receiving corrective treatment and four died later on in their clinical course due to infectious complications.
CONCLUSION The incidence of TEFs increased during the coronavirus disease 2019 pandemic (from 0.5% to 1.5%). We believe that endoscopic treatment should be considered as an option for this group of patients, since evidence reported in the literature is still a growing area. Therefore, we propose an algorithm to lead intervention in patients presenting with TEFs due to prolonged intubation.
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Affiliation(s)
- Martin Alonso Gomez Zuleta
- Department of Internal Medicine, Gastroenterology unit, Universidad Nacional de Colombia, Bogota 11321, Colombia
| | | | - Oscar Fernando Ruiz
- Department of Internal Medicine, Gastroenterology unit, Universidad Nacional de Colombia, Bogota 11321, Colombia
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20
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Bibas BJ, Peitl-Gregorio PH, Cremonese MR, Terra RM. Tracheobronchial Surgery in Emerging Countries. Thorac Surg Clin 2022; 32:373-381. [PMID: 35961745 DOI: 10.1016/j.thorsurg.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tracheobronchial surgery is widely performed in emerging countries mainly as a consequence of the high number of airway-related complications and poor management in intensive care units. This has led to great expertise in the surgical management of postintubation tracheal stenosis, and opportunity for advancing scientific knowledge. Nonetheless, tracheal stenosis has a severe impact on a patient's quality of life, is a major burden to the health system, and should be prevented. Incorporation of innovative techniques, technologies, and prospective databases should prompt earlier diagnosis and lead to fewer complications.
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Affiliation(s)
- Benoit Jacques Bibas
- Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, bloco 2, 2° andar, Sala 9, Secretaria de Cirurgia Torácica, São Paulo, São Paulo CEP 05403-904, Brazil; Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Hospital Municipal Vila Santa Catarina, São Paulo, São Paulo, Brazil
| | - Paulo Henrique Peitl-Gregorio
- Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, bloco 2, 2° andar, Sala 9, Secretaria de Cirurgia Torácica, São Paulo, São Paulo CEP 05403-904, Brazil
| | - Mariana Rodrigues Cremonese
- Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, bloco 2, 2° andar, Sala 9, Secretaria de Cirurgia Torácica, São Paulo, São Paulo CEP 05403-904, Brazil
| | - Ricardo Mingarini Terra
- Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, bloco 2, 2° andar, Sala 9, Secretaria de Cirurgia Torácica, São Paulo, São Paulo CEP 05403-904, Brazil; Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
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21
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Lu Y, Ren Z. Postoperative thoracogastric necrosis associated with thoracogastric-tracheal fistula of an endoscopic McKeown-type resection of esophageal carcinoma: A case report. Medicine (Baltimore) 2022; 101:e28755. [PMID: 35119033 PMCID: PMC8812693 DOI: 10.1097/md.0000000000028755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/17/2022] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Postoperative thoracogastric necrosis (TGN) associated with thoracogastric-tracheal fistula (TGTF) of an endoscopic McKeown-type resection of esophageal carcinoma is rare and has a poor prognosis and high mortality. Few cases have been reported and successful treatment is rare. Surgery is the major treatment option. PATIENT CONCERNS A 71-year-old man was hospitalized in a local hospital for more than 2 months due to dysphagia. The patient was previously healthy and had no underlying diseases. DIAGNOSIS TGN associated with TGTF of an endoscopic McKeown-type resection of esophageal carcinoma. INTERVENTION Two-stage surgeries were performed. OUTCOME The patient recovered well at the time of the follow-up examination on April 4, 2021 with an ECOG score of 0. CONCLUSION Staging surgery can be an alternative treatment for TGN associated with TGTF of an endoscopic McKeown-type resection of esophageal carcinoma.
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Iliocostalis Muscle Rotational Flap: A Novel Flap for Esophagopleural Fistula Repair. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4007. [PMID: 35186613 PMCID: PMC8849421 DOI: 10.1097/gox.0000000000004007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/27/2021] [Indexed: 11/26/2022]
Abstract
Intrathoracic fistulas present major challenges to reconstructive surgeons. Reconstruction with muscle flaps have been shown to improve patient outcomes; however, there are patients for whom one or more of the commonly used muscle flaps is not available for several reasons. We describe the use of an iliocostalis muscle rotational flap for the repair of a caudally located esophagopleural fistula in the setting of definitive chemoradiotherapy for treatment of nonsmall-cell lung cancer and reirradiation with photons for local recurrence 5 years later. Our repair remained intact through the nearly 12-month follow-up period during which the patient tolerated a regular diet. This report demonstrates that the iliocostalis lumborum muscle is a viable option for repair of intrathoracic fistulas that are located in the distal esophagus, even in the setting of previous thoracotomy and radiation, and should be part of the reconstructive surgeon's armamentarium in the management of intrathoracic fistulas.
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Sato Y, Tanaka Y, Suetsugu T, Takaha R, Ojio H, Hatanaka Y, Imai T, Okumura N, Matsuhashi N, Takahashi T, Kato H, Yoshida K. Three-step operation for esophago-left bronchial fistula with respiratory failure after esophagectomy: a case report with literature review. BMC Gastroenterol 2021; 21:467. [PMID: 34906075 PMCID: PMC8672548 DOI: 10.1186/s12876-021-02051-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 12/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The development of esophago-bronchial fistula after esophagectomy and reconstruction using a posterior mediastinal gastric tube remains a rare complication associated with a high rate of mortality. CASE PRESENTATION A 63-year-old man with esophageal cancer underwent a thoracoscopic esophagectomy with two-field lymph node dissection and reconstruction via a gastric tube through the posterior mediastinal route. Postoperatively, the patient developed extensive pyothorax in the right lung due to port site bleeding and hematoma infection. Four months after surgery, he developed an esophago-left bronchial fistula due to ischemia of the cervical esophagus and severe reflux esophagitis at the site of the anastomosis. Because of respiratory failure due to the esophago-bronchial fistula and the history of extensive right pyothorax, right thoracotomy and left one-lung ventilation were thought to be impossible, so we decided to perform the surgery in three-step systematically. First, we inserted a decompression catheter and feeding tube into the gastric tube as a gastrostomy and expected neovascularization to develop from the wall of the gastric tube through the anastomosis after this procedure. Second, 14 months after esophagectomy, we constructed an esophagostomy after confirming blood flow in the distal side of the cervical esophagus via gastric tube using intraoperative indocyanine green-guided blood flow evaluation. In the final step, we closed the esophagostomy and performed a cervical esophago-jejunal anastomosis to restore esophageal continuity using a pedicle jejunum in a Roux-en-Y anastomosis via a subcutaneous route. CONCLUSION This three-step operation can be an effective procedure for patients with esophago-left bronchial fistula after esophagectomy, especially those with respiratory failure and difficulty in undergoing right thoracotomy with left one-lung ventilation.
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Affiliation(s)
- Yuta Sato
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Yoshihiro Tanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan.
| | - Tomonari Suetsugu
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Ritsuki Takaha
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Hidenori Ojio
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Yuji Hatanaka
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Takeharu Imai
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Naoki Okumura
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Takao Takahashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Hisakazu Kato
- Department of Plastic and Reconstructive Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterological Surgery and Pediatric Surgery, Gifu University Graduate School of Medicine, Gifu City, Japan
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Fermi M, Lo Manto A, Ferri G, Ghirelli M, Mattioli F, Presutti L. Surgical management of benign cervical tracheoesophageal fistulas: A single-tertiary academic institution experience. Am J Otolaryngol 2021; 42:103091. [PMID: 34120009 DOI: 10.1016/j.amjoto.2021.103091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite improvements of diagnosis and management, acquired benign tracheoesophageal fistulas (AB-TEFs) remain a challenging clinical problem and a life-threating condition. In the present study, we reviewed the early results and the long-term outcomes after surgical treatment of cervical AB-TEFs treated in our institution during the last 9 years. METHODS This retrospective study included patients who underwent transcervical repair of benign cervical AB-TEFs. Patients were identified from a prospectively filled electronic database which included patients' demographics, medical history, disease presentation, prior treatments, operative report, morbidity and mortality, hospital stay, postoperative results and follow-up information. RESULTS A total of 13 patients affected by cervical AB-TEF were treated. Most of the patients (91%) in our series were treated with a lateral cervicotomic approach with interposition of either sternocleidomastoid muscle flap (72.7%) or pectoralis major myocutaneous flap (9.1%) or infrahyoid muscle flap (9.1%). The univariate analysis of showed that the etiology and surgical technique were significantly associated with immediate postoperative outcome. Esophageal diversion was removed in all patients but 3 due to their neurological status, which was the only significant factor related to post-operative oral-intake (p =0.016). We experienced 2 (18.2%) failures of the reconstruction, which occurred in patients previously treated with chemoradiation for head and neck malignancies. None of the remaining patients (72.8%) relapsed after a long-term follow-up restoring a normal oral diet was restored. CONCLUSION The lateral cervicotomic approach with sternocleidomastoid flap interposition showed its effectiveness and safety in the treatment of AB-TEFs in our single-institution experience.
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Wahi JE, Rocco D, Williams R, Safdie FM. Endoluminal management of benign bronchoesophageal fistula. BMJ Case Rep 2021; 14:e245240. [PMID: 34544721 PMCID: PMC8454450 DOI: 10.1136/bcr-2021-245240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/03/2022] Open
Abstract
The ideal management of bronchoesophageal fistulas is a debated topic. While open surgical repair remains the most definitive treatment, not all patients are fit for surgery. In this communication, we present a patient who developed a bronchoesophageal fistula 1 year after an Ivor Lewis esophagectomy that involved the native oesophagus and right mainstem bronchus. Endoluminal vacuum therapy was successful at closing this benign bronchoesophageal fistula.
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Affiliation(s)
- Jessica E Wahi
- Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Diana Rocco
- Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Roy Williams
- Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
| | - Fernando M Safdie
- Cardiothoracic Surgery, Mount Sinai Medical Center, Miami Beach, Florida, USA
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Belle A, Lorut C, Lefebvre A, Ali EA, Hallit R, Leblanc S, Bordacahar B, Coriat R, Roche N, Chaussade S, Barret M. Amplatzer occluders for refractory esophago-respiratory fistulas: a case series. Endosc Int Open 2021; 9:E1350-E1354. [PMID: 34466358 PMCID: PMC8367450 DOI: 10.1055/a-1490-9001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 03/29/2021] [Indexed: 01/21/2023] Open
Abstract
Background and study aims Endoscopic management of esophagorespiratory fistulas (ERF) is challenging and currently available options (stents, double pigtail, endoscopic vacuum therapy) are not very effective. We report the feasibility and efficacy of endoscopic placement of Amplatzer cardiovascular occluders for this indication. Patients and methods This was a single-center, prospective study (June 2019 to September 2020) of all patients with non-malignant ERF persistent after conventional management with esophageal and/or tracheal stents. The primary outcome was the technical feasibility of Amplatzer placement. Secondary outcomes were clinical success defined by effective ERF occlusion and resolution of respiratory symptoms allowing oral food intake. Results Endoscopic placement of Amplatzer occluders was feasible in 83 % of patients (5/6), with a 50 % (3/6) clinical success rate at 9 months. The mortality rate was 33 % (2/6). Conclusions An Amplatzer cardiac or vascular occluder is a feasible and safe treatment option for refractory ERF, with a 50 % short-term clinical success.
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Affiliation(s)
- Arthur Belle
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Christine Lorut
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Aurélie Lefebvre
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Einas Abou Ali
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Rachel Hallit
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Sarah Leblanc
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,Department of Hepato-Gastroenterology, Ramsay Private Hospital Jean-Mermoz, Lyon, France
| | - Benoit Bordacahar
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Nicolas Roche
- Departement of Respiratory Medicine, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Stanislas Chaussade
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
| | - Maximilien Barret
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France,University of Paris, Paris, France
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Tracheoesophageal Fistula in a COVID-19 Ventilated Patient: A Challenging Therapeutic Decision. Case Rep Surg 2021; 2021:6645518. [PMID: 33833892 PMCID: PMC8014238 DOI: 10.1155/2021/6645518] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/15/2021] [Accepted: 03/19/2021] [Indexed: 12/22/2022] Open
Abstract
COVID-19 associated severe respiratory failure frequently requires admission to an intensive care unit, tracheal intubation, and mechanical ventilation. Among the risks of prolonged mechanical ventilation under these conditions, there is the development of tracheoesophageal fistula. We describe a case of a severe COVID-19 associated respiratory failure, who developed a tracheoesophageal fistula. We hypothesized that one of the mechanisms for tracheoesophageal fistula, along with other local and general risk factors, is the local infection due to the location of the virus itself in the tracheobronchial tree. The patient was managed successfully with surgical intervention. This case highlights the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and suggests a management strategy.
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Brunner S, Bruns CJ, Schröder W. [Esophagotracheal and esophagobronchial fistulas]. Chirurg 2021; 92:577-588. [PMID: 33630123 DOI: 10.1007/s00104-021-01370-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/25/2022]
Abstract
Esophagobronchial and esophagotracheal fistulas are rare but complex diseases with a heterogeneous spectrum of underlying etiologies. Common causes are locally advanced tumors of the esophagus and larynx, traumatic perforation from the esophageal or tracheal side as well as postoperative fistulas. The management of esophagotracheal and esophagobronchial fistulas always involves different health care providers and in most cases patients require a multidisciplinary treatment on the intensive care unit. The therapeutic concept primarily depends on the underlying cause, localization and size of the fistula but decision making is also influenced by the severity of the course of sepsis and the extent of the respiratory dysfunction. Endoscopic management with esophageal and/or tracheobronchial stenting is the most common treatment. Surgical reconstructive procedures are predominantly reserved for patients with a treatment refractory fistula or a septic multiple organ failure. The prognosis is particularly influenced by the underlying disease.
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Affiliation(s)
- S Brunner
- Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinik Köln, Köln, Deutschland
| | - C J Bruns
- Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinik Köln, Köln, Deutschland
| | - W Schröder
- Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinik Köln, Köln, Deutschland.
- Chirurgische Leitung "Oberer Gastrointestinaltrakt", Klinik für Allgemein‑, Viszeral‑, Tumor- und Transplantationschirurgie, Universitätsklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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Self-Expanding Metal Stent (SEMS) Placement to Treat Bleeding from Late Radiation Esophagitis. Case Rep Gastrointest Med 2021. [DOI: 10.1155/2021/6678139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Radiation esophagitis is a serious complication occurring in patients receiving radiotherapy for head and neck cancers. Current treatment with proton pump inhibitors and mucosal protectants provides symptomatic relief with few studies showing improvement in erosive esophagitis or ulceration. Use of self-expandable metal stents (SEMS) in cases of erosive radiation esophagitis refractory to medical therapy has not been studied. We report a case of a patient presenting with recurrent hematemesis from late (chronic) radiation esophagitis with bleeding esophageal ulceration successfully treated with SEMS placement after failure of conservative medical management, proposing a possible utility for SEMS in this setting.
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30
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Multi-stage treatment of esophago-tracheal injury after button battery ingestion. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Liu X, Li Q, Huang W, Liu M, Xu X, Jiang G. Use of a Pedicled Sternocleidomastoid Musculocutaneous Flap in a Large Tracheoesophageal Fistula. Ann Thorac Surg 2020; 110:e233-e236. [PMID: 32353442 DOI: 10.1016/j.athoracsur.2020.03.072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 03/21/2020] [Indexed: 11/19/2022]
Abstract
Repairing a large tracheoesophageal fistula with extensive involvement of the membranous wall of the trachea is sometimes troublesome because of the lack of an ideal replacement for the large defect. We report the successful use of a pedicled sternocleidomastoid musculocutaneous flap to repair a large tracheoesophageal fistula in which the cutaneous component was applied to the defect of the membranous trachea after tracheal resection and the muscular component was interposed between the tracheal and esophageal walls.
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Affiliation(s)
- Xiaogang Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Qiuyuan Li
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Wei Huang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ming Liu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xinnan Xu
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Gening Jiang
- Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.
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Asaad M, Van Handel A, Akhavan AA, Huang TCT, Rajesh A, Allen MA, Shen KR, Sharaf B, Moran SL. Muscle Flap Transposition for the Management of Intrathoracic Fistulas. Plast Reconstr Surg 2020; 145:829e-838e. [PMID: 32221235 DOI: 10.1097/prs.0000000000006670] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Intrathoracic fistulas pose unique challenges for thoracic and reconstructive surgeons. To decrease the incidence of fistula recurrence, pedicled flaps have been suggested to buttress the repair site. The authors aimed to report their experience with muscle flap transposition for the management of intrathoracic fistulas. METHODS A retrospective review of all patients who underwent intrathoracic muscle flap transposition for the management of intrathoracic fistulas from 1990 to 2010 was conducted. Patient demographics, surgical characteristics, and complication rates were abstracted and analyzed. RESULTS A total of 198 patients were identified. Bronchopleural fistula was present in 156 of the patients (79 percent), and 48 had esophageal fistula (24 percent). A total of 238 flaps were used, constituting an average of 1.2 flaps per patient. After the initial fistula repair, bronchopleural fistula complicated the course of 34 patients (17 percent), and esophageal fistula occurred in 13 patients (7 percent). Partial flap loss was identified in 11 flaps (6 percent), and total flap loss occurred in four flaps (2 percent). Median follow-up was 27 months. At the last follow-up, 182 of the patients (92 percent) had no evidence of fistula, 175 (89 percent) achieved successful chest closure, and 164 (83 percent) had successful treatment. Preoperative radiation therapy and American Society of Anesthesiologists score of 4 or greater were identified as risk factors for unsuccessful treatment. CONCLUSIONS Intrathoracic fistulas remain a source of major morbidity and mortality. Reinforcement of the fistula closure with vascularized muscle flaps is a viable option for preventing dehiscence of the repair site and can be potentially life-saving. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, III.
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Affiliation(s)
- Malke Asaad
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Amelia Van Handel
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Arya A Akhavan
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Tony C T Huang
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Aashish Rajesh
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Mark A Allen
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - K Robert Shen
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Basel Sharaf
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
| | - Steven L Moran
- From the Divisions of Plastic Surgery and General Thoracic Surgery, Department of Surgery, Mayo Clinic; and the Mayo Clinic Alix School of Medicine
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Palmes D, Kebschull L, Bahde R, Senninger N, Pascher A, Laukötter MG, Eichelmann AK. Management of Nonmalignant Tracheo- and Bronchoesophageal Fistula after Esophagectomy. Thorac Cardiovasc Surg 2020; 69:216-222. [PMID: 32114691 DOI: 10.1055/s-0039-1700970] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Tracheo- or bronchoesophageal fistula (TBF) occurring after esophagectomy represent a rare but devastating complication. Management remains challenging and controversial. Therefore, the purpose of this study was to evaluate the outcome of different treatment approaches and to propose recommendations for the management of TBF. METHODS From 2008 to 2018, 15 patients were treated because of TBF and were analyzed with respect to fistula appearance, treatment strategy (stenting, endoscopic vacuum therapy and/or surgical reintervention) and outcome. RESULTS In each case, the fistula was small, located close to the tracheal bifurcation and associated simultaneously (n = 6, 40%) or metachronously (n = 9, 60%) with an anastomotic leakage. Latter was covered by esophageal stents in six patients which in turn resulted in occurrence of TBF at a later time in five patients. Management of TBF included conservative therapy (n = 3), stenting (n = 6), or suturing (n = 6). Ten patients underwent rethoracotomy. Treatment failure was observed in eight patients (53%). In all patients, treatment was accompanied by progressive sepsis. On the contrary, all seven patients with successful defect closure remained in good general condition. CONCLUSION Fistula appearance was similar in all patients. Implementation of esophageal stents cannot be recommended because of possibility of TBF at a later time point. Surgery is usually required and should preferably be performed when the patient's condition has been optimized at a single-stage repair. Esophageal diversion can only be recommended in patients with persisting mediastinitis. The key element for successful treatment of TBF, however, is control over sepsis; otherwise, outcome of TBF is devastating.
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Affiliation(s)
- Daniel Palmes
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Linus Kebschull
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Ralf Bahde
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Norbert Senninger
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Andreas Pascher
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Mike G Laukötter
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
| | - Ann-Kathrin Eichelmann
- Department of General, Visceral and Transplant Surgery, University Hospital of Muenster, Münster, Germany
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Mammana M, Comacchio GM, Schiavon M, Zuin A, Natale G, Faccioli E, Fortarezza F, Pezzuto F, Rea F. Repair of Adult Benign Tracheoesophageal Fistulae With Absorbable Patches: Single-Center Experience. Ann Thorac Surg 2019; 109:1086-1094. [PMID: 31760058 DOI: 10.1016/j.athoracsur.2019.09.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 09/17/2019] [Accepted: 09/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND This group previously reported on the repair of a wide tracheoesophageal fistula with a bioabsorbable patch. The current study describes a consecutive series of patients operated on using the same technique. METHODS Data of patients undergoing surgical closure of tracheoesophageal fistula at a single center from 2011 to 2018 were extracted and analyzed. RESULTS An absorbable patch was used in 8 of 23 patients (34.8%) operated on for tracheoesophageal fistula during the study period. Causes of the fistulae included postintubation injury (n = 6), mediastinal radiotherapy (n = 1), and a complication of lung resection (n = 1). The median fistula size was 27.5 mm (range, 15 to 45 mm). In 3 patients, the surgical approach was through cervicotomy and in 5 it was through right thoracotomy. Prosthetic materials consisted of Gore Bio-A (W.L. Gore & Associates, Inc, Newark, DE) tissue reinforcement in 6 patients and polyglactin 910 knitted mesh in 2 patients. In every case, the prosthesis was covered with a pedicled muscle flap. The esophageal defect was treated by primary closure in 7 patients and by esophageal exclusion in 1. Fistula recurrence and postoperative death occurred in 1 patient (12.5%), whereas 7 patients experienced postoperative complications (87.5%). Five patients resumed oral intake, and 3 breathed without a tracheal appliance. Compared with the other patients, in those who underwent repair of their fistula using a prosthesis, the median size of the airway defect was larger, morbidity was greater, and the rate of resumption of oral intake was lower. CONCLUSIONS Repair of tracheoesophageal fistulae with synthetic prostheses is feasible and may be effective in complex cases. Further research is needed to identify the ideal prosthetic material.
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Affiliation(s)
- Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giovanni M Comacchio
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Marco Schiavon
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Andrea Zuin
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Giuseppe Natale
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Eleonora Faccioli
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Francesco Fortarezza
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federica Pezzuto
- Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
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Sikka K, Singh CA, Agrawal R, Kumar R, Thakar A, Sharma SC. Acquired Non-malignant Cervical Trachea-Esophageal Fistula: A Case Series. Indian J Otolaryngol Head Neck Surg 2019; 71:286-290. [PMID: 31741974 DOI: 10.1007/s12070-018-1281-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 02/15/2018] [Indexed: 12/01/2022] Open
Abstract
Acquired non-malignant trachea-esophageal fistula (TEF) of cervical oesophagus is rare. Surgical closure of fistula is the standard treatment of choice. Our experience in management of such cases is presented. Five cases of acquired cervical TEF of varying etiology were retrospectively analysed. Two patients had history of migrated endoluminal stent. All the patients were treated by trans-cervical repair with muscle interposition. Tracheal Stenosis in two patients was managed concurrently. Successful repair was achieved in four cases. One patient with chronic obstructive pulmonary disease and active leprosy has residual fistula. Of the two patients with tracheal stenosis correction one was decannulated 6 month later and second has stent in situ. Post-operative vocal cord palsy occurred in one patient. Transcervical repair with muscle interposition is treatment of choice in cases of acquired nonmalignant cervical tracheoesophageal fistulas. Endoluminal stents have high tendency to migrate and are not recommended.
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Affiliation(s)
- Kapil Sikka
- 1Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Chirom Amit Singh
- 1Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Rakesh Kumar
- 1Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Alok Thakar
- 1Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Suresh C Sharma
- 1Department of Otolaryngology Head Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
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36
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Dhiwakar M, Ronen O, Supriya M, Mehta S. Surgical repair of mechanical ventilation induced tracheoesophageal fistula. Eur Arch Otorhinolaryngol 2019; 277:323-331. [PMID: 31705278 DOI: 10.1007/s00405-019-05723-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the outcomes of surgery to repair tracheoesophageal fistula (TEF) caused by mechanical ventilation. METHOD Case series and review of all cases reported in English literature. Only reports of TEF following mechanical ventilation and containing description of surgical repair and outcomes were included. RESULTS A total of 41 studies comprising 143 patients met the inclusion criteria. Most studies had incomplete information on important variables such as co-morbidity and fistula size. Tracheal resection anastomosis (TRA) was the most common approach, performed in 91 (63.6%) patients (including three newly reported here). Lateral approach repair (LA) was done in 45 (31.5%) patients. The former had a higher incidence of pre-existing tracheal stenosis [53 (89.8%) vs. 7 (35%) cases; p < 0.001]. Flap interposition to augment the repair was done in 49 (53.9%) and 40 (88.9%) cases, respectively (p < 0.001). Successful and durable healing of the fistula were achieved in 90 (98.9%) cases in TRA and 39 (88.6%) cases in LA. CONCLUSION In carefully selected cases of TEF caused by mechanical ventilation, TRA is the most preferred approach, delivering successful healing in almost all cases. Where TRA is not indicated or preferred, LA appears to be a good alternative. Future studies should explicitly report all of the known co-variables, so that the exact indications for choosing a particular surgical approach could be better elucidated.
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Affiliation(s)
- Muthuswamy Dhiwakar
- Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India.
| | - Ohad Ronen
- Galilee Medical Center, Bar-Ilan University, Safed, Israel
| | | | - Shivprakash Mehta
- Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India
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Okamoto K, Ninomiya I, Fujiwara Y, Mochizuki I, Aoki T, Yamaguchi T, Terai S, Nakanuma S, Kinoshita J, Makino I, Nakamura K, Miyashita T, Tajima H, Takamura H, Fushida S, Ohta T. Use of esophageal stent for the treatment of postoperative gastrointestinal-airway fistula after esophagectomy. Esophagus 2019; 16:413-417. [PMID: 31062120 DOI: 10.1007/s10388-019-00673-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 04/30/2019] [Indexed: 02/03/2023]
Abstract
A gastrointestinal-airway fistula (GAF) after esophagectomy is a very serious postoperative complication that can cause severe respiratory complications due to digestive juice inflow. Generally, GAF is managed by invasive surgical treatment; less-invasive treatment has yet to be established. We performed esophageal stent placement (ESP) in three cases of GAF after esophagectomy. We assessed the usefulness of ESP through our clinical experience. All GAFs were successfully managed by ESP procedures. After the procedure, the stent positioning and expansion were appropriately evaluated by radiological assessments over time. The stent was removed after endoscopic confirmation of fistula closure on days 8, 23, and 71. Only one patient with a long-term indwelling stent developed a manageable secondary gastrobronchial fistula as a procedure-related complication. In conclusion, ESP was shown to be a less-invasive and effective therapeutic modality for the treatment of GAF.
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Affiliation(s)
- Koichi Okamoto
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Itasu Ninomiya
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan.
| | - Yuta Fujiwara
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Ichitaro Mochizuki
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tatsuya Aoki
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Takahisa Yamaguchi
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shiro Terai
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Shinichi Nakanuma
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Jun Kinoshita
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Isamu Makino
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Keishi Nakamura
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tomoharu Miyashita
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hidehiro Tajima
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Hiroyuki Takamura
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Sachio Fushida
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
| | - Tetsuo Ohta
- Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takara-Machi, Kanazawa, Ishikawa, 920-8641, Japan
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38
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Mann C, Musholt TJ, Babic B, Hürtgen M, Gockel I, Thieringer F, Lang H, Grimminger PP. [Surgical treatment of esophagotracheal and esophagobronchial fistulas]. Chirurg 2019; 90:722-730. [PMID: 31384993 DOI: 10.1007/s00104-019-1006-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Esophagotracheal and esophagobronchial fistulas are pathological communications between the airway system and the digestive tract, which often lead to major pulmonary complications with a high mortality. Endoscopic treatment is the primary therapeutic approach; however, in cases of failure early surgical treatment is obligatory. METHODS This article describes the clinical course of patients with esophagotracheal and esophagobronchial fistulas treated in this hospital over a period of 10 years. Patients were retrospectively analyzed with respect to the etiology of fistulas, management, in particular to the operative procedures, complications and outcome. RESULTS Between 2009 and 2019, a total of 15 patients with esophagotracheal and esophagobronchial fistula were treated in this hospital. Of these 12 underwent an endoscopic intervention, of which 5 were successful. In total, eight patients needed surgical intervention, six of the eight surgically treated patients recovered fully, one had a recurrent fistula, which was successfully treated by subsequent endoscopy after surgery and one patient died. DISCUSSION Management of esophagotracheal and esophagobronchial fistulas is challenging. This retrospective analysis reflects the published data with a success rate of endoscopic treatment in approximately 50%. Surgical intervention should be carried out after unsuccessful endoscopic treatment or if endoscopic treatment is primarily not feasible. Direct closure with resorbable sutures or reconstruction with alloplastic or allogeneic material should be preferred. For larger defects or high proximal esophagotracheal fistulas local transposition of muscular flaps or free muscular flaps play a major role. During operative closure of high intrathoracic or cervical fistulas, intraoperative neuromonitoring can be useful to prevent nerve damage.
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Affiliation(s)
- C Mann
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - T J Musholt
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - B Babic
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - M Hürtgen
- Klinik für Thoraxchirurgie, Katholisches Klinikum Koblenz-Montabaur, Koblenz, Deutschland
| | - I Gockel
- Klinik und Poliklinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, AöR, Leipzig, Deutschland
| | - F Thieringer
- I. Medizinische Klinik, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - H Lang
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland.
| | - P P Grimminger
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
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Chaddha U, Hogarth DK, Murgu S. Perspective on airway stenting in inoperable patients with tracheoesophageal fistula after curative-intent treatment for esophageal cancer. J Thorac Dis 2019; 11:2165-2174. [PMID: 31285911 DOI: 10.21037/jtd.2018.12.128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Udit Chaddha
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
| | - D Kyle Hogarth
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
| | - Septimiu Murgu
- Division of Pulmonary and Critical Care, University of Chicago Medical Center, The University of Chicago Medicine, Chicago, IL 60637, USA
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40
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Larson B, Adler DG. Endoscopic management of esophagorespiratory fistulas. TECHNIQUES IN GASTROINTESTINAL ENDOSCOPY 2019. [DOI: 10.1016/j.tgie.2019.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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41
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Tracheoesophageal fistula due to a displaced external tracheal stent repaired using a local flap composed of intercostal muscle and rib periosteum. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2018.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Qureshi YA, Muntzer Mughal M, Markar SR, Mohammadi B, George J, Hayward M, Lawrence D. The surgical management of non-malignant aerodigestive fistula. J Cardiothorac Surg 2018; 13:113. [PMID: 30442164 PMCID: PMC6238307 DOI: 10.1186/s13019-018-0799-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Accepted: 11/05/2018] [Indexed: 01/07/2023] Open
Abstract
Background Acquired aerodigestive fistula (ADF) are rare, but associated with significant morbidity. Surgery affords the best prospect of cure. We present our experience of the surgical management of ADFs at a specialist unit, highlighting operative techniques, challenges and assess clinical outcomes following intervention. We also illustrate findings of a Hospital Episodes Statistics search for ADFs. Methods A prospectively-maintained database was searched to identify all patients diagnosed with an ADF who were managed at our institution. Of 48 patients with an ADF, eight underwent surgical intervention. Results Four patients underwent an exploration of the ADF with primary repair of the defect. Two of these patients had proximal ADFs, amenable to repair through a neck incision, and two required a thoracotomy. Two patients suffered fistulae secondary to endoscopic therapy and underwent oesophageal exclusion surgery, with subsequent staged reconstruction. Two patients with previous Tuberculosis had a lung segmentectomy and lobectomy respectively, and a further patient in remission after treatment for lymphoma underwent oesophageal resection with synchronous reconstruction. Three patients suffered a complication, with one post-operative mortality. The remaining seven patients all achieved normal oral alimentation, with no evidence of ADF recurrence at a median follow-up of 32 months. Conclusions Surgery to manage ADFs is effective in restoring normal alimentation and alleviates soiling of the airway, with a very low risk of recurrence. Several operative techniques can be utilised dependent on the features of the ADF. Early referral to specialist units is advocated, where the expertise to facilitate the complete management of patients is present, within a multi-disciplinary setting.
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Affiliation(s)
- Yassar A Qureshi
- Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU, UK.
| | - M Muntzer Mughal
- Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU, UK
| | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Borzoueh Mohammadi
- Department of Oesophago-Gastric Surgery, University College London Hospital, 250 Euston Road, London, NW1 2BU, UK
| | - Jeremy George
- Department of Thoracic Medicine, University College London Hospital, London, UK
| | - Martin Hayward
- Department of Thoracic Surgery, University College London Hospital, London, UK
| | - David Lawrence
- Department of Thoracic Surgery, University College London Hospital, London, UK
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43
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Youness HA, Harris K, Awab A, Keddissi JI. Bronchoscopic advances in the management of aerodigestive fistulas. J Thorac Dis 2018; 10:5636-5647. [PMID: 30416814 DOI: 10.21037/jtd.2018.05.44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Malignant aerodigestive fistula (ADF) is an uncommon condition complicating thoracic malignancies. It results in increased morbidity and mortality and warrants therapeutic intervention. The management approach depends on symptoms, configuration, location, and extent of the fistula. This article will discuss the therapeutic considerations in the management of ADF.
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Affiliation(s)
- Houssein A Youness
- Oklahoma City VA Health Care system, Oklahoma City, OK, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kassem Harris
- Interventional Pulmonary Section, Department of Medicine, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Ahmed Awab
- University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jean I Keddissi
- Oklahoma City VA Health Care system, Oklahoma City, OK, USA.,University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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44
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Nakano Y, Takao T, Morita Y, Sakaguchi H, Tanaka S, Ishida T, Toyonaga T, Umegaki E, Kodama Y. Endoscopic plombage with polyglycolic acid sheets and fibrin glue for gastrointestinal fistulas. Surg Endosc 2018; 33:1795-1801. [PMID: 30251142 DOI: 10.1007/s00464-018-6454-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/18/2018] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND STUDY AIMS Gastrointestinal (GI) fistulas arise as adverse events of GI surgery and endoscopic treatment as well as secondary to underlying diseases, such as ulceration and pancreatitis. Until a decade ago, they were mainly treated surgically or conservatively. Bioabsorbable polyglycolic acid (PGA) sheets and fibrin glue, which are commonly used in surgical procedures, have also recently been used in endoscopic procedures for the closure of GI defects. However, there have only been few case reports about successful experiences with this approach. There have not been any case-series studies investigating the strengths and weaknesses of such PGA sheet-based treatment. In this study, we evaluated the clinical effectiveness of using PGA sheets to close GI fistulas. PATIENTS AND METHODS Cases in which patients underwent endoscopic filling with PGA sheets and fibrin glue for GI fistulas at Kobe University Hospital between January 2013 and April 2018 were retrospectively reviewed. RESULTS A total of 10 cases were enrolled. They included fistulas due to leakage after GI surgery, aortoesophageal/bronchoesophageal fistulas caused by chemoradiotherapy, or severe acute pancreatitis. The fistulas were successfully closed in 7 cases (70%). The unsuccessful cases involved a fistula due to leakage after surgical esophagectomy and bronchoesophageal fistulas due to chemoradiotherapy or severe acute pancreatitis. Unsuccessful treatment was related to fistula epithelization. CONCLUSION Endoscopic plombage with PGA sheets and fibrin glue could be a promising therapeutic option for GI fistulas.
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Affiliation(s)
- Yoshiko Nakano
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Toshitatsu Takao
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan.
| | - Yoshinori Morita
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Hiroya Sakaguchi
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Shinwa Tanaka
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Tsukasa Ishida
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | | | - Eiji Umegaki
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
| | - Yuzo Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, Hyogo, Japan
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Wang H, Ke M, Li W, Wang Z, Li H, Cong M, Zeng Y, Chen L, Lai G, Xie B, Zhang N, Li W, Zhou H, Wang X, Lin D, Zhou Y, Zhang H, Li D, Song X, Wang J, Wu S, Tao M, Sha Z, Tan Q, Han X, Luo L, Ma H, Wang Z. Chinese expert consensus on diagnosis and management of acquired respiratory-digestive tract fistulas. Thorac Cancer 2018; 9:1544-1555. [PMID: 30221470 PMCID: PMC6209773 DOI: 10.1111/1759-7714.12856] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 01/21/2023] Open
Abstract
Acquired respiratory‐digestive tract fistulas occur with abnormal communication between the airways and digestive tract, causing the interflow of gas and liquid. Despite advances in surgical methods and the development of multimodal therapy in recent years, patients with acquired respiratory‐digestive tract fistulas continue to exhibit unfavorable clinical outcomes. Therefore, in order to guide clinical practice in China, the Respiratory and Cancer Intervention Alliance of the Beijing Health Promotion Association organized a group of experienced experts in the field to develop this consensus document. Based on a study of clinical application and expert experience in the diagnosis and management of acquired respiratory‐digestive tract fistulas at home and abroad, an Expert Consensus was developed. The panelists recruited comprised experts in pulmonology, oncology, thoracic surgery, interventional radiology, and gastroenterology. PubMed, Chinese Biology Abstract, Chinese Academic Journal, and Wanfang databases were used to identify relevant articles. The guidelines address etiology, classification, pathogenesis, diagnosis and management of acquired respiratory‐digestive tract fistulas. The statements on treatment focus on the indications for different procedures, technical aspects, and preprocedural, post‐procedural and complication management. The proposed guidelines for the diagnosis and management of acquired respiratory‐digestive tract fistulas are the first to be published by Chinese experts. These guidelines provide an in‐depth review of the current evidence and standard of diagnosis and management.
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Affiliation(s)
- Hongwu Wang
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China.,Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Mingyao Ke
- Department of the Respiratory Centre, Xiamen Second Hospital, Teaching Hospital of Xiamen Medical University, Xiamen, China
| | - Wen Li
- Department of Gastroenterology, Chinese People's Liberation Army (PLA) General Hospital and Chinese PLA Medical School, Beijing, China
| | - Zikai Wang
- Department of Gastroenterology, Chinese People's Liberation Army (PLA) General Hospital and Chinese PLA Medical School, Beijing, China
| | - Hui Li
- Department of Thoracic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Minghua Cong
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yiming Zeng
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, China
| | - Liangan Chen
- Department of Respiratory Medicine, Chinese People's Liberation Army (PLA) General Hospital and Chinese PLA Medical School, Beijing, China
| | - Guoxiang Lai
- Department of Pulmonary and Critical Care Medicine, Dongfang Hospital Affiliated to Xiamen University, Fuzhou, China
| | - Baosong Xie
- Department of Respiratory and Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Medical College, Fujian Medical University, Fuzhou, China
| | - Nan Zhang
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Wangping Li
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xian, China
| | - Hongmei Zhou
- Department of Respiratory Medicine, Zhongshan Hospital, Guangdong Medical University, Zhongshan, China
| | - Xiaoping Wang
- Respiratory Endoscopy Center, Shandong Chest Hospital, Jinan, China
| | - Dianjie Lin
- Department of Respiratory Medicine, Shandong Provincial Hospital, Shandong University, Jinan, China
| | - Yunzhi Zhou
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Huaping Zhang
- Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Center of Respiratory Medicine of Fujian Province, Quanzhou, China
| | - Dongmei Li
- Department of Respiratory Medicine, Meitan General Hospital, Beijing, China
| | - Xiaolian Song
- Department of Respiratory Medicine, Shanghai Tenth People's Hospital, Tongji University, Shanghai, China
| | - Juan Wang
- Department of Respiratory Medicine, Tangdu Hospital, Fourth Military Medical University, Xian, China
| | - Shiman Wu
- Department of Respiratory Medicine, The First Affiliated Hospital of Shangxi Medical University, Taiyuan, China
| | - Meimei Tao
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Zhengbu Sha
- Department of Thoracic Surgery, The Third Affiliated Hospital, Xuzhou Medical University, Xuzhou, China
| | - Qiang Tan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xinwei Han
- Department of Interventional Radiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.,Respiratory Department, Interventional Institute of Zhengzhou University, Zhengzhou, China
| | - Lingfei Luo
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Hongming Ma
- Department of Medical Oncology, Meitan General Hospital, Beijing, China
| | - Zhiqiang Wang
- Department of Gastroenterology, Chinese People's Liberation Army (PLA) General Hospital and Chinese PLA Medical School, Beijing, China
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Endoscopic management of recurrent tracheoesophageal fistula induced by chronic use of nonsteroidal anti-inflammatory drugs: A case report and review of the literature. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MÉDECINE INTERNE 2018; 56:211-215. [PMID: 29742066 DOI: 10.2478/rjim-2018-0014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Indexed: 11/20/2022]
Abstract
Tracheoesophageal fistula (TEF) is frequently congenital and requires surgical correction. TEF can also occur secondary to malignant esophageal tumors or benign diseases and these cases are managed by endoscopic means, such as closing the defect with metallic stents. Although esophageal injury can occur secondary to nonsteroidal anti-inflammatory drugs (NSAIDs), TEF secondary to chronic NSAIDs use has not been described in the literature. We report the case of a male patient with refractory migraine and chronic use of NSAIDs, with a history of esophageal stenosis presenting with acute-onset total dysphagia. Upper gastrointestinal endoscopy and CT-scan revealed TEF located at 25 cm from the incisors. An esophageal stent was placed endoscopically, and 6 weeks a second stent was placed in a stent-in-stent manner to allow removal of both stents. Endoscopic control after the removal of the stents showed the persistence of the fistula, so a third stent was placed as a rescue therapy. Against medical advice, the patient continued to use OTC painkillers and NSAIDs in large doses. Three months later, he was readmitted with total dysphagia and recent-onset dysphonia. CT scan revealed a new fistula above the already placed stent. A second metallic stent was endoscopically placed through the old stent to close the newly developed fistula. The patient was discharged on the third day with no complications and he remains well at 6 months follow-up. Due to small cases studies, recurrent TEF remains a therapeutic challenge. Endoscopic therapy is usually an effective solution, but complex cases might require multiple treatment sessions.
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Yanagihara T, Ichimura H, Kobayashi K, Sato Y. Successful Surgical Closure of an Esophagobronchial Fistula Caused by a Foreign Body in the Esophagus of a Female Octogenarian with a Delayed Diagnosis: A Case Report. Ann Thorac Cardiovasc Surg 2018; 27:126-131. [PMID: 29863037 PMCID: PMC8058548 DOI: 10.5761/atcs.cr.18-00077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Esophagobronchial fistula (EBF) caused by an esophageal foreign body is rare in adults. All surgical interventions in the reported cases were performed via right thoracotomy. We have successfully treated an 88-year-old woman with EBF caused by a thick 2 × 2 cm piece of cake decorating paper that was swallowed accidentally. There was a 2-month interval between ingestion of the foreign body and correct diagnosis. The bronchial opening of the EBF was on the cephalic wall of the proximal left main bronchus (LMB), so we planned a primary repair of the bronchial wall with sutures via left thoracotomy. We performed a division of the fistula and primary closure of the openings on the esophageal and bronchial walls and covered the suture sites with an intercostal muscle flap and pericardial fat, respectively. The patient resumed oral intake on postoperative day 11 and was subsequently transferred to other hospital for rehabilitation.
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Affiliation(s)
- Takahiro Yanagihara
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Hideo Ichimura
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, Japan.,Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keisuke Kobayashi
- Department of Thoracic Surgery, Hitachi General Hospital, Hitachi, Ibaraki, Japan
| | - Yukio Sato
- Department of Thoracic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Bibas BJ, Cardoso PFG, Minamoto H, Pêgo-Fernandes PM. Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:210. [PMID: 30023373 DOI: 10.21037/atm.2018.05.25] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Benign tracheoesophageal fistula (TEF) results from an abnormal communication between the posterior wall of the trachea or bronchi and the adjacent anterior wall of the esophagus. It can be acquired or congenital. The onset of the TEF has a negative impact on the patient's health status and quality of life because of swallowing difficulties, recurrent aspiration pneumonia, and severe weight loss. Several acquired conditions may cause TEF. The most frequent is prolonged orotracheal intubation (75% of the cases). Usually, there is an erosion of the tracheal and esophageal wall by the continuous pressure between the endotracheal tube and the esophageal wall; particularly in the presence of a nasogastric or feeding tube within the esophageal lumen. Furthermore, tracheal stenosis is often associated, and adds complexity to the disease. Preparation for the surgical procedure may take weeks or even months. It includes definitive weaning from mechanical ventilation, treatment of respiratory infection, physiotherapy, and correction of malnutrition through enteral feeding. Surgical repair of a TEF is an elective procedure. It consists of division of the fistula, suture of the esophagus and trachea and protection of the suture lines with a buttressed muscle flap. TEF repair is a complex and challenging procedure, thus, high morbidity and mortality are expected. Nonetheless, surgical management yields excellent long-term results, and it should be considered the first-line treatment for this condition. Definitive fistula closure occurs in about 90-95% of the cases.
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Affiliation(s)
- Benoit Jacques Bibas
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Helio Minamoto
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Manoel Pêgo-Fernandes
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Ersoz H, Nazli C. A new method of tracheoesophageal fistula treatment: Using an atrial septal defect occluder device for closure-The first Turkish experience. Gen Thorac Cardiovasc Surg 2018; 66:679-683. [PMID: 29730753 DOI: 10.1007/s11748-018-0933-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 04/30/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE One of the techniques used in the treatment of tracheoesophageal fistula is applying the umbrella catheter, designed for closure of atrial septal defects, in this region. In the literature, we have encountered only 9 case reports in this regard. We shared a successfully closed tracheoesophageal fistula case with this technique. CASE A tracheoesophageal fistula in a 47-year-old male patient was successfully closed with an atrial septal defect occluder device. The patient died on the 42nd day after the procedure with no atrial septal defect occluder device-related problems. CONCLUSION Using of atrial septal defect occluder device may be an appropriate option for tracheoesophageal fistula treatment. It can be said that the procedure is successful when the device is completely covered. Even so, there is a need for multi-centered, randomized, controlled studies of large series about the subject.
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Affiliation(s)
- Hasan Ersoz
- Department of Thoracic Surgery, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey. .,Izmir Katip Celebi Universitesi Ataturk Egitim ve Arastirma Hastanesi, Gogus Cerrahisi Klinigi, Karabaglar, 35150, Izmir, Turkey.
| | - Cem Nazli
- Department of Cardiology, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey
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An unusual late complication in traumatic brain injury: Persistent dysphagia due to tracheoesophageal fistula. Turk J Phys Med Rehabil 2018; 64:170-172. [PMID: 31453508 DOI: 10.5606/tftrd.2018.1547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/12/2017] [Indexed: 11/21/2022] Open
Abstract
Traumatic brain injury (TBI), which leads to cognitive, physical, emotional and behavioral deficits according to the severity of trauma, is a disability with high morbidity and mortality. In addition to primary effects of TBI, direct trauma to the face, neck, and chest also contributes to increased morbidity. Recovery in swallowing functions in TBI patients is often parallel with recovery in functional daily activities. Herein, contrary to that expectation, we present a TBI case with persistent dysphagia symptoms lasting for even 1.5 years after trauma, despite the fact that she gained independence in dailylife activities under supervision.
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