Surgical Treatment Outcomes of Acquired Benign Tracheoesophageal Fistula: A Literature Review

Abstract

Background: Tracheoesophageal fistula (TEFs) is a rare condition that requires complex surgical treatment. We analyzed the surgical outcomes of TEF reported in the literature and at Pusan National University Yangsan Hospital using standardized techniques. Methods: This retrospective study included 8 patients diagnosed with acquired benign TEF between March 2010 and December 2019. The surgical method was determined based on the size of the fistula observed within the endoscope. Results: TEF occurred in 7 patients (87.5%) after intubation or tracheostomy and in 1 patient (12.5%) after esophageal surgery due to conduit necrosis. For tracheal management, 5 and 2 patients underwent tracheal resection and end-to-end anastomosis and primary repair, respectively. The median length of resection was 2.5 cm (range, 1.3-3.4 cm). For esophageal management, 6 patients underwent primary repair and 1 patient underwent esophageal diversion. One patient underwent TEF division with a stapler. Interposition of a muscle flap was performed in 2 patients. TEF recurrence, esophageal stenosis, and dehiscence or granulation occurred in 1, 1, and 2 patients, respectively. A long-term tracheostomy tube or T-tube was used in 2 patients for >2 months. Conclusion: Although TEF surgery is complex and challenging, good results can be achieved if surgical standards are established and experience is accumulated.

Analysis of the Application Value of Different Esophagography Techniques in the Diagnosis of H-Type Tracheoesophageal Fistula in Neonates

“…The findings of the present study are also supported by the literature [ 3 ]. Given the pathological characteristics and pathogenesis of H-TEF and the limitations of various diagnostic techniques, this study employed the triple-lumen double-balloon catheter technique, blocking the upper and lower ends of the oesophagus with balloons and creating a positive pressure in the oesophagus with contrast media [ 22 – 24 ] to detect whether a fistula existed. The triple-lumen double-balloon catheter technique proved a significant application value for the diagnosis of H-TEF.…”

Acquired tracheo-esophageal fistula in adult—a classical case of ‘what not to do’

“…TEF from malignancy accounts for more than 50% of acquired TEFs [ 1 ]. The major causes of acquired non-malignant TEFs include postintubation injury, chronic infections (e.g., tuberculosis), radiation injury, and post-surgical lesions [ 2 , 3 ]. The management strategy for TEF should encompass multiple facets of the disease, which include identifying the underlying etiology, goals of care, and assessing the stability.…”

“…The major causes of acquired non-malignant TEFs include postintubation injury, chronic infections (e.g., tuberculosis), radiation injury, and post-surgical lesions [ 1 ]. Several modalities like fibrin glue injection, atrial closure devices, and endoscopic repairs have been described in the management of TEF [ 2 , 3 ]. Non-surgical interventions have very limited role in such lesions and lead to recurrence as seen in this case.…”

Manejo quirúrgico de fístula traqueoesofágica en paciente con COVID-19

“…1 Los síntomas clínicos típicos de un paciente con FTE son tos asociada a la ingesta de alimento, acompañado de disnea y disfagia progresivas. 2 El diagnóstico se confirma a través de broncoscopia o esofagoscopia, teniendo la primera mejor sensibilidad. 1 El cierre espontáneo de una FTE es poco probable y el tratamiento quirúrgico se requiere en la mayoría de los casos.…”

“…3 Los objetivos primarios de la cirugía con intento curativo son el cierre primario de la fistula y prevenir la recurrencia con la interposición de un parche. [1][2][3] Los pacientes críticos con neumonía por COVID-19 requieren intubación y ventilación mecánica por varios días, lo que puede dar lugar a múltiples complicaciones, entre ellas, el desarrollo de una fístula traqueoesofágica. 4 Se presenta el caso de una paciente con COVID-19 que desarrolló una fístula traqueoesofágica y se trató quirúrgicamente de forma exitosa.…”