Evaluation and outcome of different surgical techniques for postintubation tracheoesophageal fistulas

Abstract

Postintubation tracheoesophageal fistula is usually best treated with tracheal or laryngotracheal resection and anastomosis with primary esophageal closure even in the absence of tracheal damage.

Postintubation Tracheoesophageal Fistula - Diagnosis, Treatment and Prognosis

“…The samples of such cases described in the literature include a limited number of patients and usually cover long periods of time (6,8,9,14,15); actually, our sample comprises a number of 11 cases over a 10-year period, although our department is prominent in tracheal surgery. On the one hand, this complication is rare, but on the other hand, not all patients that have it qualify for major surgery, especially due to the underlying condition that required prolonged mechanical ventilation in the first place.…”

“…The options in this case are either oesophageal diversion, or emergency surgery with tracheal resection. Emergency resection of the air duct (if stenosis is present) can also be considered when the fistula is diagnosed in the first 24 to 48 hours from extubation, in patients with a satisfactory health status and lung contamination at minimum levels (6,16,17).…”

“…In this case, the fistula can be approached from the side, but layering a tissue flap between the two suture points is still recommended, especially since the sutures are now at the same level. An anterior transtracheal approach is much more convenient to perform (in particular for surgeons with tracheal surgery experience), as it enables a clear assessment of injuries to the trachea which, if not affected by stenosis, may present ischemic, inflammatory, malacic injuries that, unless resected, might result in various problems, including delayed stenosis, requiring subsequent surgery (6).…”

“…With this type of tubes, an approximately 15 mmHg pressure is enough to guarantee sealing of the ventilation tube (5). Other risk factors leading to TEF are: excessive movement of the tracheostomy tube (in case of smaller-thanneeded diameter), restlessness, malnutrition, hypotension, sepsis, steroid treatment and diabetes (6). Surgical treatment is standard, as the operation is the only solution for these patients; usually, such fistulas are large in size, sometimes detected late, with a fistulous opening that is well epithelialized, which makes it virtually impossible to close spontaneously or through conventional methods (7).…”

Surgical approaches in surgery for cicatrical tracheal stenosis

“…Это важно учитывать при планировании операции с использо-ванием оригинальных инструментов. Не всегда раз-ные доступы позволяют оперировать с удобным углом наклона инструментов, применять сшиваю-щие аппараты (например, в хирургии трахеопище-водного свища) [7,9,14,19,21]. Другим фактором, ограничивающим комфорт хирургу, является нали-чие в операционном поле различных трубок для обеспечения ИВЛ.…”