Post-Intubation Tracheoesophageal Fistula; A Nine-Year Experience

Document Type: Original Article

Authors

1 General thoracic surgeon, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Massih Daneshvari Hospital, Tehran, Iran

2 General thoracic surgeon, Tracheal Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Massih Daneshvari Hospital, Tehran, Iran

3 General practitioner, Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Massih Daneshvari Hospital, Tehran, Iran

Abstract

Introduction: Tracheoesophageal fistula (TEF) is a rare condition, which could be life-threatening if diagnosed late or mismanaged. Post-intubation TEF is the most common form of acquired, non-malignant TEF and is usually associated with tracheal stenosis, which makes the treatment more challenging. Here, we present our experience of managing 21 patients with post-intubation TEF.  
Materials & Methods: Twenty one patients including seven women and fourteen men with mean age of 38.05 years, who had post-intubation TEF were managed in our center (Massih Daneshvari Hospital, Tehran, Iran) during 2004-2013. None of the patients were operated before weaning from mechanical ventilation. Single division and closure of the fistula was performed in one patient who did not have accompanying tracheal stenosis. One-stage surgical repair including tracheal resection, anastomosis, primary closure of the esophageal defect, and muscle flap Interposition was the main treatment method in all other cases. Patients were followed up for at least two years.
Results: Excellent and good results achieved in 85.7% of our patients. Major complications including permanent vocal cord paralysis and recurrence of tracheal stenosis necessitating T-tube insertion occurred in two patients (9.5%). Severe cachexia and sepsis secondary to sputum retention resulted in one mortality (4.8%).
Conclusion: Surgery might provide the best treatment results along with low mortality and morbidity rates in post-intubation TEFs if performed within the proper time.

Keywords

References

  1. Diddee R, Shaw IH. Acquired tracheo-oesophageal fistula in adults. Contin Educ Anaesth Crit Care Pain. 2006; 6:105-8.
  2. Baisi A, Bonavina L, Narne S, Peracchia A. Benign tracheoesophageal fistula: results of surgical therapy. Dis Esophagus. 1999; 12:209-11.
  3. Couraud L, Ballester MJ, Delaisement C. Acquired tracheoesophageal fistula and its management. Semin Thorac Cardiovasc Surg. 1996; 8:392-9.
  4. Camargo JJ, Machuca TN, Camargo SM, Lobato VF, Medina CR. Surgical treatment of benign tracheo-oesophageal fistulas with tracheal resection and oesophageal primary closure: is the muscle flap really necessary? Eur J Cardiothorac Surg. 2010; 37:576-80.
  5. Mooty RC, Rath P, Self M, Dunn E, Mangram A. Review of tracheo-esophageal fistula associated with endotracheal intubation. J Surg Educ. 2007; 64:237-40.
  6. Dartevelle P, Macchiarini P. Management of acquired tracheoesophageal fistula. Chest Surg Clin N Am. 1996; 6:819-36.
  7. Reed MF, Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am. 2003; 13:271-89.
  8. Athanassiadi K, Gerazounis M. Repair of postintubation tracheoesophageal fistula in polytrauma patients. Injury. 2005; 36:897-9.
  9. Grillo HC. Development of tracheal surgery: a historical review. Part 2: Treatment of tracheal diseases. Ann Thorac Surg. 2003; 75:1039-47.
  10. Freire JP, Feijó SM, Miranda L, Santos F, Castelo HB. Tracheo-esophageal fistula: combined surgical and endoscopic approach. Dis Esophagus. 2006; 19:36-9.
  11.  Gudovsky LM, Koroleva NS, Biryukov YB, Chernousov AF, Perelman MI. Tracheoesophageal fistulas. Ann Thorac Surg. 1993; 55:868-75.
  12. Wesselhoeft CW Jr, Keshishian JM. Acquired nonmalignant esophagotracheal and esophagobronchial fistulas. Ann Thorac Surg. 1968; 6:187-95.
  13.  Flege JB Jr. Tracheoesophageal fistula caused by cuffed tracheostomy tube. Ann Surg. 1967; 166:153-6.
  14. Shen KR, Allen MS, Cassivi SD, Nichols FC, Wigle DA, Harmsen WS, et al. Surgical management of acquired nonmalignant tracheoesophageal and bronchoesophageal fistulae. Ann Thorac Surg. 2010; 90:914–8.
  15. Muniappan A, Wain JC, Wright CD, Donahue DM, Gaissert H, Lanuti M, et al. Surgical treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experience. Ann Thorac Surg. 2013; 95:1141-6.
  16.  Eleftheriadis E, Kotzampassi K. Temporary stenting of acquired benign tracheoesophageal fistulas in critically ill ventilated patients. Surg Endosc. 2005; 19:811-5.
  17. Scappaticci E, Ardissone F, Baldi S, Coni F, Revello F, Filosso PL, et al. Closure of an iatrogenic tracheo-esophageal fistula with bronchoscopic gluing in a mechanically ventilated adult patient. Ann Thorac Surg. 2004; 77:328-9.
  18.  Antonelli M, Cicconetti F, Vivino G, Gasparetto A. Closure of a tracheoesophageal fistula by bronchoscopic application of fibrin glue and decontamination of the oral cavity. Chest. 1991; 100:578-9.
  19. Scappaticci E, Ruffini E, Oliaro A, Mancuso M, Filosso PL, Rastelli M. Iatrogenic esophago-tracheal fistula treated with endoscopically administered fibrin glue. Minerva Chir. 1993; 48:1107-9.
  20. Grillo HC, Moncure AC, McEnany MT. Repair of Inflammatory Tracheoesophageal Fistula. Ann Thorac Surg. 1976; 22:112-9.
Journal of Cardio-Thoracic Medicine

Volume 5, Issue 3
Summer 2017
Pages 177-180

Files

Share

How to cite

Statistics