Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings

Erdim, İbrahim; Sirin, Ali Ahmet; Baykal, Bahadır; Oğhan, Fatih; Guvey, Ali; Kayhan, Fatma Tülin

doi:10.1016/j.bjorl.2016.06.011

Cited by 10 publications

(13 citation statements)

References 20 publications

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“…12,16,[19][20][21] The esophageal and tracheal repairs are then buttressed together using alloderm, intercostal muscle flaps, omental flaps, or other free flaps. 12,17,18,22 Our case offers a novel surgical approach using a pedicled TCA flap to buttress the tracheal and esophageal closures in the repair of a nonmalignant acquired TEF. Tessler et al describe the TCA flap as being a reliable pedicle with a reproducible and easy dissection.…”

Section: Discussionmentioning

confidence: 97%

Transverse Cervical Artery Flap Repair of Benign Acquired Tracheoesophageal Fistula

Artz

Yoo

Gilbert-Fernández

et al. 2019

J Reconstr Microsurg Open

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Acquired tracheoesophageal fistulas are rare but associated with significant morbidity and mortality. The majority of cases are due to prolonged or complicated endotracheal intubation, tracheostomy, or esophageal malignancy, or subsequent to radiation or chemotherapy for treatment of the latter. Other etiologies include esophageal stenting and complications secondary to endoscopic procedures. The pathophysiology involves chronic inflammation of the esophagus or posterior wall of the trachea, ultimately promoting fistulization between these two structures. Risk factors primarily depend on the etiology; however, excessive balloon pressures and prolonged intubation are among the strongest predictors of acquired tracheoesophageal fistula. In two reported cases, intubation with persistent air leaks resulted in fistulization. Patients present with refractory pneumonia, aspiration, hypoxemia, acute respiratory distress, enteral feed in endotracheal aspirate, or gastric distention following extubation. It can be difficult to distinguish normal functional deterioration from deterioration secondary to intubation. Up to 51% of patients intubated for at least 48 hours may experience dysphagia following extubation. Ultimately, the diagnostic algorithm includes an esophagogram, followed by imaging with computed tomography (CT) scan, and, more recently, CT scan with three-dimensional reconstructions, a bronchoscopy, and an esophagoscopy. Spontaneous closure rarely occurs, and the primary treatment modalities include interventional therapy with stenting via bronchoscopy, esophagoscopy, or surgical correction. Surgical intervention is associated with higher risks due to surrounding vital anatomy and, often, technical challenges requiring multispecialty care. Our case study presents a novel and effective method of repairing a benign acquired tracheoesophageal fistula utilizing the transverse cervical artery flap.

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Section: Discussionmentioning

confidence: 97%

Transverse Cervical Artery Flap Repair of Benign Acquired Tracheoesophageal Fistula

Artz

Yoo

Gilbert-Fernández

et al. 2019

J Reconstr Microsurg Open

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“…Prosthesis replacement with a different‐sized prosthesis can also be considered. Silicone ring enhancement is also reported to be successful in selected cases, especially in patients with previous radiotherapy as this technique has no effect on wound healing . Submucosal purse‐string method, defined by Jacob, aims to narrow the enlarged TEP.…”

Section: Discussionmentioning

confidence: 99%

“…Silicone ring enhancement is also reported to be successful in selected cases, especially in patients with previous radiotherapy as this technique has no effect on wound healing. 3 Submucosal purse-string method, defined by Jacob, 4 aims to narrow the enlarged TEP. As a surgical method, having the advantage of preserving voice, it is not applicable to larger fistulas.…”

Section: Discussionmentioning

confidence: 99%

“…Conservative methods preserve voice by incomplete closure of the TEF by removing the voice prosthesis with placement of a nasogastric tube to prevent aspiration and waiting for spontaneous narrowing of the fistula. Insertion of a new prosthesis, replacement with silicone ring expanded prosthesis, purse‐string suture or injection of different materials like collagen or hyaluronic acid to decrease the diameter of the TEP can be used alone or in combination with other options …”

Section: Introductionmentioning

confidence: 99%

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A simple and effective method for closure of enlarged tracheoesophageal puncture in seven patients

Gözen

Tevetoğlu

Eker

et al. 2019

Clinical Otolaryngology

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“…The TEF repair surgeries are high risk surgeries with a mortality rate of 10.9%; the recurrent rate of the fistulas is 7.9% and post-operative delayed tracheal stenosis has been reported to occur on 2.6% [82]. Endoscopic closure of small fistula, or inoperable ones using fibrin glue [81], cardiac septal defect occluders [83] or silicon rings [84] have been reported in few case reports. Single or dual esophageal and/or tracheal stent placement has been used for palliation in cases where TEF is resulted from malignant underlying diseases [81].…”

mentioning

confidence: 99%

Long-Term Complications of Tracheal Intubation

Touman¹,

Stratakos²

2018

Tracheal Intubation

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Endotracheal intubation is an intervention frequently performed in the hospital setting in order to protect the central airway and provide mechanical support of ventilation. Many health care providers are expected to be able to intubate the patients for different indications. As the case in any medical intervention, endotracheal intubation can cause complications. These complications are categorized as early or late according to the time of onset of the presenting symptoms. This chapter will discuss the long term complications of endotracheal intubation that might be encountered by the treating physicians. The chapter will stress on the predisposing factors for these complications and the available methods to avoid and treat them.

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Treatment of large persistent tracheoesophageal peristomal fistulas using silicon rings

Abstract: Silicon rings for modified expanded voice prosthesis seems to be an effective treatment for persistent peri-prosthetic leakage, for both, fistula closure and preserving the patients speech.

Cited by 10 publications

References 20 publications

Transverse Cervical Artery Flap Repair of Benign Acquired Tracheoesophageal Fistula

Transverse Cervical Artery Flap Repair of Benign Acquired Tracheoesophageal Fistula

A simple and effective method for closure of enlarged tracheoesophageal puncture in seven patients

Long-Term Complications of Tracheal Intubation

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