PS01.101: Surgical Management of Adult Esophago-Respiratory Fistula: A Ten-Year Experience.

Abstract

Background Adult esophago-respiratory fistula is a rare condition, which is usually seen in malignancies or in benign conditions following trauma, infection or as a delayed presentation of congenitall tracheoesophageal fistula. They pose a technical challenge in stabilisation and management requiring multidisciplinary approach. Methods In this retrospective analysis of such cases over a period of ten years, who presented to our centre. The aetiology, presentation and treatment modalities were studied in detail. Of these,18 patients with benign esophago repiratory fistulae underwent surgical correction oft he same. This is discussed in detail. Results There were a total of 62 cases of adult esophago-respiratory fistula, over the 10 year period. Of the patients, 34 of the cases to be of malignant etiology and 28 of the cases to be of benign etiology such as prolonged tracheostomy, corrosive injury, infection, trauma or delayed presentation of congenital fistula. The mean age of presentation was 44 years. (range 18 to 81 years of age). There were 35 tracheoesophageal fistulae and 27 bronchoesophageal fistulae. Fourteen patients underwent esophageal stenting and 9 underwent tracheal stenting either as a temporary intervention to alleviate symptoms or as palliative intervention. Eighteen patients underwent definitive surgical intervention. Surgical repair involved approach through neck in 6 patients and thorax in 11 patients and a combination of both approaches in one patient. The esophageal end of the fistula was primarily closed or closed with the help of a pleural or pedicled muscle flap or a subtotal esophagectomy was performed. The respiratory end of the fistula was either primarily closed or with the help of a vascularized patch of the esophageal wall. The latter technique was used in four patients and is explained in detail. Conclusion Due to risk of fatal complications, early diagnosis, multidisciplinary approach and appropriate surgical intervention after nutritional build up is the key to successful management of adult esophago-respiratory fistula. Disclosure All authors have declared no conflicts of interest.