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Yuan P, Bibas BJ, Nagashima T, Chen HYM, Poggi C, Chen F, Hu Y. Successful repair of acquired intrathoracic nonmalignant tracheoesophageal fistulas using thoracoacromial artery perforator flap through a midsternal incision approach: a report of three cases. J Thorac Dis 2023; 15:5122-5133. [PMID: 37868901 PMCID: PMC10586943 DOI: 10.21037/jtd-23-1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/31/2023] [Indexed: 10/24/2023]
Abstract
Background Acquired intrathoracic nonmalignant tracheoesophageal fistulas (TEFs) are rare and challenging surgical problems. They can constitute a life-threatening condition due to severe pulmonary complications and poor nutrition. Surgical treatment is effective for most patients undergoing operative repair. However, in recent studies, the difficult-to-ignore early complications of surgical treatment can be as high as 62.5%. Among them, esophageal stricture occurring in 42-54% of patients, anastomosis leakage occurs at a rate of 22.7-26%, and the mortality rate can be as high as 29.4%. Here, we introduce our innovative experience repairing acquired TEFs with a thoracoacromial artery perforator flap, in which provides a clear surgical field of view, reliable reconstruction, and no serious complications during the perioperative period and no mortality or complications were observed within 180 days after the operation. Case Description Surgical repair with a thoracoacromial artery perforator flap through a midsternal incision approach was performed in 3 patients. During the procedure, a midsternal incision was made. After the thymus and anterior mediastinal fat were resected, and the left innominate vein was transected, the trachea and esophagus were mobilized. The trachea was incised and pulled to the cranial and caudal sides. Then, the thoracoacromial artery perforator flap was harvested and transferred into the superior mediastinum for esophageal reconstruction. Subsequently, the trachea was anastomosed end to end after debridement, and the left innominate vein was either anastomosed or not. Two patients developed esophageal anastomotic leakage postoperatively and healed well after nonsurgical treatment. No mortality or other complications were observed at 180 days after the operation. Conclusions Repair of acquired TEFs using a thoracoacromial artery perforator flap through a midsternal incision approach is an effective, safe surgical treatment.
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Affiliation(s)
- Peisong Yuan
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Benoit Jacques Bibas
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Takuya Nagashima
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Hei-Yu Matthew Chen
- Department of Cardiothoracic Surgery, Queen Elizabeth Hospital, Kowloon, Hong Kong, China
| | - Camilla Poggi
- Division of Thoracic Surgery, Department of General and Specialistic Surgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Fei Chen
- Department of Otolaryngology-Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Hu
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
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Rotolo N, Cattoni M, De Maio S, Filipponi L, Mateo-Ramos P, Imperatori A. The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient. Monaldi Arch Chest Dis 2023; 93. [PMID: 36786164 DOI: 10.4081/monaldi.2023.2490] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/16/2022] [Indexed: 02/10/2023] Open
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.
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Affiliation(s)
- Nicola Rotolo
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Maria Cattoni
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Silvia De Maio
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Luca Filipponi
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Pau Mateo-Ramos
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
| | - Andrea Imperatori
- Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese.
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3
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Huang S, Zhu S, Guo S, Zhao X. Purse-string suture combined with titanium clips using a single-channel gastroscope for the closure of postintubation tracheoesophageal fistula. Endoscopy 2022; 54:E707-E708. [PMID: 35226935 DOI: 10.1055/a-1769-4481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Shu Huang
- Department of Gastroenterology, People's Hospital of Lianshui, Huaian, P. R. China
| | - Sumin Zhu
- Department of Gastroenterology, Second Affiliated Hospital, Xuzhou Medical University, Xuzhou, P. R. China
| | - Siming Guo
- Department of Gastroenterology, Second Affiliated Hospital, Xuzhou Medical University, Xuzhou, P. R. China
| | - Xuan Zhao
- Department of Gastroenterology, Second Affiliated Hospital, Xuzhou Medical University, Xuzhou, P. R. China
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Bibas BJ, Peitl-Gregorio PH, Cremonese MR, Terra RM. Tracheobronchial Surgery in Emerging Countries. Thorac Surg Clin 2022; 32:373-381. [PMID: 35961745 DOI: 10.1016/j.thorsurg.2022.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Tracheobronchial surgery is widely performed in emerging countries mainly as a consequence of the high number of airway-related complications and poor management in intensive care units. This has led to great expertise in the surgical management of postintubation tracheal stenosis, and opportunity for advancing scientific knowledge. Nonetheless, tracheal stenosis has a severe impact on a patient's quality of life, is a major burden to the health system, and should be prevented. Incorporation of innovative techniques, technologies, and prospective databases should prompt earlier diagnosis and lead to fewer complications.
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Affiliation(s)
- Benoit Jacques Bibas
- Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, bloco 2, 2° andar, Sala 9, Secretaria de Cirurgia Torácica, São Paulo, São Paulo CEP 05403-904, Brazil; Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil; Hospital Municipal Vila Santa Catarina, São Paulo, São Paulo, Brazil
| | - Paulo Henrique Peitl-Gregorio
- Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, bloco 2, 2° andar, Sala 9, Secretaria de Cirurgia Torácica, São Paulo, São Paulo CEP 05403-904, Brazil
| | - Mariana Rodrigues Cremonese
- Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, bloco 2, 2° andar, Sala 9, Secretaria de Cirurgia Torácica, São Paulo, São Paulo CEP 05403-904, Brazil
| | - Ricardo Mingarini Terra
- Division of Thoracic Surgery, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Eneas de Carvalho Aguiar 44, bloco 2, 2° andar, Sala 9, Secretaria de Cirurgia Torácica, São Paulo, São Paulo CEP 05403-904, Brazil; Hospital Israelita Albert Einstein, São Paulo, São Paulo, Brazil.
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García-Herreros LG, Jiménez A, Cabrera LF, Vinck EE, Pedraza M. Early presentation of post-intubation tracheoesophageal fistula with severe tracheal stenosis in COVID-19 patient. Ann R Coll Surg Engl 2021; 103:e144-e147. [PMID: 33682425 DOI: 10.1308/rcsann.2020.7065] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The current global COVID-19 pandemic is caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Currently, acquired tracheoesophageal fistulas are mainly iatrogenic lesions produced by prolonged tracheal intubation. We present a case of tracheoesophageal fistula with severe tracheal stenosis following tracheal intubation in a patient with SARS-CoV-2 infection.
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Affiliation(s)
- L G García-Herreros
- Fundación Santa Fé de Bogotá, Bogotá, Colombia.,Universidad de los Andes, Bogotá, Colombia
| | - A Jiménez
- Fundación Santa Fé de Bogotá, Bogotá, Colombia
| | - L F Cabrera
- Fundación Santa Fé de Bogotá, Bogotá, Colombia.,Universidad de los Andes, Bogotá, Colombia.,Universidad El Bosque, Bogota, Colombia
| | - E E Vinck
- Universidad El Bosque, Bogota, Colombia.,Dr Horacio Oduber Hospitaal, Aruba
| | - M Pedraza
- Universidad El Bosque, Bogota, Colombia
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Dhiwakar M, Ronen O, Supriya M, Mehta S. Surgical repair of mechanical ventilation induced tracheoesophageal fistula. Eur Arch Otorhinolaryngol 2019; 277:323-331. [PMID: 31705278 DOI: 10.1007/s00405-019-05723-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 11/05/2019] [Indexed: 12/18/2022]
Abstract
PURPOSE To evaluate the outcomes of surgery to repair tracheoesophageal fistula (TEF) caused by mechanical ventilation. METHOD Case series and review of all cases reported in English literature. Only reports of TEF following mechanical ventilation and containing description of surgical repair and outcomes were included. RESULTS A total of 41 studies comprising 143 patients met the inclusion criteria. Most studies had incomplete information on important variables such as co-morbidity and fistula size. Tracheal resection anastomosis (TRA) was the most common approach, performed in 91 (63.6%) patients (including three newly reported here). Lateral approach repair (LA) was done in 45 (31.5%) patients. The former had a higher incidence of pre-existing tracheal stenosis [53 (89.8%) vs. 7 (35%) cases; p < 0.001]. Flap interposition to augment the repair was done in 49 (53.9%) and 40 (88.9%) cases, respectively (p < 0.001). Successful and durable healing of the fistula were achieved in 90 (98.9%) cases in TRA and 39 (88.6%) cases in LA. CONCLUSION In carefully selected cases of TEF caused by mechanical ventilation, TRA is the most preferred approach, delivering successful healing in almost all cases. Where TRA is not indicated or preferred, LA appears to be a good alternative. Future studies should explicitly report all of the known co-variables, so that the exact indications for choosing a particular surgical approach could be better elucidated.
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Affiliation(s)
- Muthuswamy Dhiwakar
- Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India.
| | - Ohad Ronen
- Galilee Medical Center, Bar-Ilan University, Safed, Israel
| | | | - Shivprakash Mehta
- Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India
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Bibas BJ, Cardoso PFG, Minamoto H, Pêgo-Fernandes PM. Surgery for intrathoracic tracheoesophageal and bronchoesophageal fistula. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:210. [PMID: 30023373 DOI: 10.21037/atm.2018.05.25] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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.
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Affiliation(s)
- Benoit Jacques Bibas
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Francisco Guerreiro Cardoso
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Helio Minamoto
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paulo Manoel Pêgo-Fernandes
- Division of Thoracic Surgery, Heart Institute (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Simões CA, Ribeiro IT, De Souza Medeiros JF, Castro Neto NP, Person OC, Dedivitis RA, Cernea CR. Tracheoesophageal fistula diagnosis during open tracheostomy. Lung India 2018; 35:187-189. [PMID: 29487265 PMCID: PMC5846279 DOI: 10.4103/lungindia.lungindia_368_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Cesar Augusto Simões
- Department of Head and Neck, University of Santo Amaro School of Medicine, São Paulo, Brazil
| | | | | | - Ney P Castro Neto
- Department of ENT, University of Santo Amaro School of Medicine, São Paulo, Brazil
| | - Osmar Clayton Person
- Department of ENT, University of Santo Amaro School of Medicine, São Paulo, Brazil
| | | | - Cláudio Roberto Cernea
- Department of Head and Neck, University of Santo Amaro School of Medicine, São Paulo, Brazil
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