Slide Tracheoplasty for Repair of Complex Tracheoesophageal Fistulas

Abstract

Objectives/Hypothesis: Repair of large, recurrent, and complex tracheoesophageal fistulas (TEFs) is challenging and numerous different surgical approaches exist. These various techniques each carry a set of risks and possible complications such as fistula recurrence, tracheal stenosis or pouches, esophageal stenosis, and recurrent laryngeal nerve injury. Slide tracheoplasty is a reconstructive technique successfully used in many different airway pathologies, including TEF repair. This study examines the success, limits, and complications related to slide tracheoplasty for repair of complex TEFs.Study Design: Retrospective chart review. Methods: Patients undergoing TEF repair using a cervical or thoracic approach slide tracheoplasty, at a single institution, between July 2008 and December 2019 were retrospectively reviewed. Demographic data, comorbidities, TEF etiology and surgical history, slide tracheoplasty details and outcomes, and postoperative complication data were examined using descriptive statistics.Results: Twenty-six patients underwent 27 slide tracheoplasties for TEF (20 cervical approaches, 7 thoracic approaches) with a mean age of 5.2 years (IQR 0.7-7.6) at time of surgery. The most common TEF etiologies included congenital (n = 13), tracheostomy tube erosion (n = 5), and button battery ingestion (n = 4). Fistulas ranged in size from <0.5 mm to 4 cm and 59% had previous endoscopic or open repairs. There were two TEF recurrences (7.4%), one of which was successfully revised and the other which was treated with stent placement. Postoperative complications included dehiscence (3.7%), unilateral vocal fold paralysis (3.7%), and mild tracheal stenosis (18.5%).Conclusions: Slide tracheoplasty is an effective surgical technique for treating complex congenital and acquired TEFs with lower rates of complications when compared to other techniques.

Multidisciplinary Advanced Surgical Planning for Slide Tracheoplasty Using 3D‐Printed Models

“…In a patient with a large (3 cm) TEF, we were able to design cartilage interposition flaps to strengthen the esophageal repair, a surgical technique that is beneficial in these cases but is infrequent in the experience of any single surgeon. 14 Other additional surgical steps the models were useful for planning included post-operative tracheostomy placement, carinal reconstruction, and determining the length of necessary cartilage resection. In all cases, the in vivo CSTs were carried out in a fashion consistent with that determined by the ASP session.…”

“…Four of the models were utilized for planning concurrent cardiac procedures including aortopexy, innominate artery re‐implantation, and pulmonary artery sling repair. In a patient with a large (3 cm) TEF, we were able to design cartilage interposition flaps to strengthen the esophageal repair, a surgical technique that is beneficial in these cases but is infrequent in the experience of any single surgeon 14 . Other additional surgical steps the models were useful for planning included post‐operative tracheostomy placement, carinal reconstruction, and determining the length of necessary cartilage resection.…”

Characteristics and Outcomes of Surgical Treatment for Bronchial Anomalies

“…2,9 As a testament to its versatility, STP has been adapted to successfully address lesions that extend into the bronchus such as congenital bronchial stenosis, other abnormal tracheobronchial arborizations, and tracheoesophageal and bronchoesophageal fistulas. 4,[10][11][12] In a study of 150 children who underwent STP, the repair was extended into a bronchus in 36% of cases. 13 Complete bronchial rings were the most common reason for surgical intervention in this study.…”