gms | German Medical Science

18. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie

Deutsche Gesellschaft für Thoraxchirurgie

08.10. bis 10.10.2009, Augsburg

Tracheoesophageal fistula – possibilites of treatment. 15 years of single-centre experience

Meeting Abstract

  • Tibor Krajc - Department of Thoracic Surgery, Bratislava, Slovak Republic
  • Svetozar Harustiak - Department of Thoracic Surgery, Bratislava, Slovak Republic
  • Roman Benej - Department of Thoracic Surgery, Bratislava, Slovak Republic
  • Miroslav Janik - Department of Thoracic Surgery, Bratislava, Slovak Republic
  • Martin Lucenic - Department of Thoracic Surgery, Bratislava, Slovak Republic

Deutsche Gesellschaft für Thoraxchirurgie. 18. Jahrestagung der Deutschen Gesellschaft für Thoraxchirurgie. Augsburg, 08.-10.10.2009. Düsseldorf: German Medical Science GMS Publishing House; 2009. DocPO1.1

DOI: 10.3205/09dgt60, URN: urn:nbn:de:0183-09dgt603

Veröffentlicht: 20. November 2009

© 2009 Krajc et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.de). Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.


Gliederung

Text

Background: The location, extent and etiology of tracheoesophageal fistula, as well as patient’s general status determine the appropriate strategy and surgical approach in treatment of this condition. Based on a retrospective review of 26 cases the authors present the possible etiology of fistulae, preoperative steps necessary and operative procedures available.

Methods: We employed various known techniques: segmental tracheal resection and sutures at different levels (11) including Grillo's posterior flap resurfacing (3), fistula discision followed by muscular flap interposition between sutures (2), excision of the fistula via tracheostomy (1), stapler separation via right posterolateral thoracotomy (1), palliative Montgomery T-tube only (6), T-tube followed by rib cartilage tracheoplasty (1), resection of gastric tube, esophagostomy and muscle-periosteal flap in a case with tracheo-neoesophageal fistula. Preoperatively, all patients with were breathing spontaneously, were mostly fed via nutritive jejunostomy and had a suction gastrostomy to prevent reflux.

Results: No intraoperative deaths ocurred. All tracheal anastomoses healed sufficiently. No permanent recurrent nerve palsy or esophageal stenosis occurred in patients with benign fistulae. We found suturing the tracheal and esophageal wall at separate levels to be sufficient enough to prevent recurrence, thus making muscular flap interposition obsolete. The low supracarinal fistula we dealt with via right thoracotomy possibly resulted from a razor-blade ingestion many years before its clinical manifestation. We have unsuccessfully attempted to treat a fistula between the middle third of trachea and an orthotopically placed gastric tube (21 days after esophagectomy with extensive transcervical esophageal mobilization) by removing the neoesophagus, constructing a cervical esophagostomy and reinforcing the tracheal suture with a muscle-periosteal flap.

Conclusions: Since the incidence of tracheoesophageal fistula is low, each patient requires an individual approach, bearing in mind his/her ability to cough, nutritional state, strict enough adherence to adequate preoperative measures and suitability of various surgical techniques.