Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis

Puma, Francesco; Vannucci, Jacopo; Santoprete, Stefano; Urbani, Moira; Cagini, Lucio; Andolfi, Marco; Potenza, Rossella; Daddi, Niccolò

doi:10.21037/jtd.2017.02.17

Cited by 13 publications

(13 citation statements)

References 27 publications

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“…In the report by Muniappan and colleagues (9), 13 patients had failed initial surgical or endoscopic repairs; one fistula recurred and could not be closed. Furthermore, other series have reported complications and fistula recurrence after prior failed operations, often requiring a permanent tracheal appliance (1,10,14). In our cohort, 3 patients had failed prior TEF repairs (1).…”

Section: Resultsmentioning

confidence: 82%

“…All of them had uneventful recoveries (1). Other authors have also reported excellent results with this technique (11,13,14). Even though the trachea is incised and a primary anastomosis is performed, post-operative tracheal stenosis does not seem to be an issue.…”

Section: Tef Less Than 5 MM In Diameter Without Tracheal Stenosismentioning

confidence: 83%

“…Surgery for TEF is challenging and its morbidity rate is not negligible. In fact, the complication rate has been reported to be between 32% and 56%, mainly anastomotic issues or fistula recurrences (14). Since benign acquired TEF is an uncommon condition, reported complications following this type of operation are limited to a few retrospective case series from large referral centers for airway diseases.…”

Section: Post-operative Complicationsmentioning

confidence: 99%

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Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula

et al. 2018

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Benign tracheoesophageal fistula (TEF) results from an abnormal communication between the posterior wall of the trachea or bronchi and the adjacent anterior wall of the esophagus. It can be acquired or congenital. The onset of the TEF has a negative impact on the patient's health status and quality of life because of swallowing difficulties, recurrent aspiration pneumonia, and severe weight loss. Several acquired conditions may cause TEF. The most frequent is prolonged orotracheal intubation (75% of the cases). Usually, there is an erosion of the tracheal and esophageal wall by the continuous pressure between the endotracheal tube and the esophageal wall; particularly in the presence of a nasogastric or feeding tube within the esophageal lumen. Furthermore, tracheal stenosis is often associated, and adds complexity to the disease. Preparation for the surgical procedure may take weeks or even months. It includes definitive weaning from mechanical ventilation, treatment of respiratory infection, physiotherapy, and correction of malnutrition through enteral feeding. Surgical repair of a TEF is an elective procedure. It consists of division of the fistula, suture of the esophagus and trachea and protection of the suture lines with a buttressed muscle flap. TEF repair is a complex and challenging procedure, thus, high morbidity and mortality are expected. Nonetheless, surgical management yields excellent long-term results, and it should be considered the first-line treatment for this condition. Definitive fistula closure occurs in about 90-95% of the cases.

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Section: Resultsmentioning

confidence: 82%

Section: Tef Less Than 5 MM In Diameter Without Tracheal Stenosismentioning

confidence: 83%

Section: Post-operative Complicationsmentioning

confidence: 99%

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Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula

et al. 2018

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“…2,7,8 Several therapeutic methods such as endoluminal stenting, fibrin glue application, and surgical correction have been described for post-intubation TEF; however, single stage operation approach is preferred choice over previous multi-stage operation. 4,7,9 Prolonged ventilation induced TEF usually develops after 15-200 days. In our case, intubation duration was 11 days which was shorter than reported in the literature; 5,10 however, multiple intubations due to tube blockade, restlessness, and use of steroid for suspected meningococcal/tubercular meningitis might be the predisposing factors for TEF early in our case.…”

Section: Discussionmentioning

confidence: 99%

Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report

Rana¹,

Sapkota²,

Shakya³

et al. 2018

J Nepal Med Assoc

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Tracheoesophageal fistula is an abnormal communication between trachea and esophagus. Benign acquired types are rare with the incidence of less than 1%. Prolonged endotracheal intubation remains the most common cause. We are reporting a 28 years old female patient presented with chief complaint of a cough after each meal intake in the outpatient clinic. She had a recent history of admission in the intensive care unit with prolonged intubation (11 days). Her general physical examination, laboratory examination, and chest x-ray were normal. Esophagogastroscopy was performed and revealed communication between upper esophagus and trachea approximately at 14-17cm embedded in longitudinal mucosal folds of the esophagus. She was referred to the higher center for surgical repair. Though, a rare complication, high suspicion is necessary to accurately diagnose the disease in a patient with the history of prolonged intubation.

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“…Tracheoesophageal fistula (TEF) is a complication of prolonged mechanical ventilation,[ 1 2 3 4 ] and the diagnosis is not always performed before tracheostomy.…”

mentioning

confidence: 99%

Tracheoesophageal fistula diagnosis during open tracheostomy

et al. 2018

Lung India

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Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis

Cited by 13 publications

References 27 publications

Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula

Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula

Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report

Tracheoesophageal fistula diagnosis during open tracheostomy

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