Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula

Abstract

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.

Acquired tracheoesophageal fistula in a pregnant patient with COVID-19 pneumonia on prolonged invasive ventilation

“…Otherwise, should the aetiology be a non-malignant one, corrective surgery is undertaken as an elective procedure. 7 The procedure in itself is a complex one, and preparation may take weeks to months. 7 In general, patients are ideally weaned off the ventilator in order to minimise the high airway pressures that may inadvertently cause suture dehiscence.…”

Identification of acquired tracheoesophageal fistula after tracheostomy decannulation by videofluoroscopic swallowing study

“…The exact site can be described with anatomical reference points, such as the vocal folds in a proximal fistula, and the tracheal carina in a distal fistula. [ 10 ] TEF can also be diagnosed using a CT airway, which demonstrates the fistulous tract. [ 10 ]…”

A unique approach for a large intra-thoracic traumatic tracheo-oesophageal fistula: A case report from Syria

“…Chest wall crush injuries that occur in road-traffic accidents from the impact of steering wheel are the main reason for traumatic fistulas [ 3 , 4 ]. In penetrating chest trauma, the location of fistula is determined by the perforation site [ 5 ] and shrapnel track. Contrast radiography and using fiberoptic with endo- or bronchoscopy are the main methods of diagnosis for TOF.…”

“…Contrast radiography and using fiberoptic with endo- or bronchoscopy are the main methods of diagnosis for TOF. Furthermore, endo- or bronchoscopy can provide more details as they can determine the exact location and extension of TOF [ 5 , 6 ]. Traumatic TOF management usually follows guidelines which include patient assessment, the location of the fistula, detection and treatment of any respiratory infection, and patient's nutrition status.…”