The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient

Abstract

In the COVID-19 era the tracheal complications due to prolonged mechanical ventilation have significantly increased. Acquired tracheoesophageal fistula is one of those in ventilated COVID-19 patients. Thus, the knowledge of their management in such fragile patient is crucial. We report a case of tracheoesophageal fistula in a 56-year-old female under prolonged mechanical ventilation for COVID-19 bilateral pneumonia and discuss its management. A surgical approach was proposed. By a collar-shaped transverse cervicotomic access, we transected the trachea at level of fistula en-bloc with the tracheostoma. The esophageal lesion was longitudinally repaired in two-layers. Protective left strap muscle was sandwiched between esophagus and trachea. The tracheal end-to-end anastomosis was completed without a re-tracheostoma. Even if surgical approach of tracheoesophageal fistula in COVID-19 patients has not been tested before, surgery remains the treatment of choice according to the multidisciplinary board.

Tracheoesophageal Fistula as a Complication of Prolonged Ventilation in COVID-19: Description of Reconstruction and Review of the Literature

“…7 Other less favorable techniques that have been reported in the literature include esophageal reconstruction with full thickness skin graft, cervical esophagostomy, or esophageal diversion/esophagocolonoplasty. 4,6,7,8 TEFs commonly occur at the cervicothoracic junction, 9 and in some cases a sternotomy may be necessary to improve exposure of the carina.…”

“…10 The pedicled strap muscle flap is utilized most often, with the sternocleidomastoid a popular alternative. 4,8 The pectoralis major muscle flap is a reliable option for reconstruction throughout the head and neck [11][12][13] but its reported use is limited for COVID-19 patients and TEF.…”