Early and late outcome after surgical treatment of acquired non-malignant tracheo-oesophageal fistulae

Eur J Cardiothorac Surg. 2013 Jun;43(6):e155-61. doi: 10.1093/ejcts/ezt069. Epub 2013 Feb 26.

Abstract

Objectives: Tracheo-oesophageal fistula (TOF) is a rare, life-threatening condition. We report our results of surgical treatment and evaluation of the outcome of acquired non-malignant TOF.

Methods: Twenty-five patients (aged 49 ± 21 years) with TOF were operated on between 2001 and 2011. Tracheo-oesophageal fistula was due to prolonged intubation/tracheostomy (84%), was secondary to other surgery (8%) or trauma (4%) or was idiopathic (4%). The tracheal defect was 2.4 ± 1.3 cm long and was associated with tracheal stenosis in seven (28%) patients. Surgical treatment consisted of direct suturing of the oesophageal defect in two layers (or end-to-end oesophageal resection and anastomosis in one case) associated with tracheal suturing (n = 15; 60%), tracheal resection and anastomosis (n = 8; 32%) or covering of a large tracheal defect by an intercostal muscle flap or by a resorbable patch with muscle apposition (n = 2; 8%). The surgical approach was cervicotomy (n = 14; 56%), cervicotomy plus median sternotomy or split (n = 6; 24%), thoracotomy (n = 4; 16%) or cervicotomy plus sternal spit plus thoracotomy (n = 1; 4%). In 18 (72%) cases a muscular flap was used and in six (24%) a protective tracheostomy was performed.

Results: No perioperative deaths occurred. Morbidity occurred in eight (32%) patients; none of them required a second surgical look. At median follow-up of 41 months, the outcome was excellent or good for 22 patients (88%), two (8%) are still dependent on jejunostomy and tracheostomy for neurological diseases and one (4%) is under mechanical ventilation for end-stage respiratory failure.

Conclusions: Surgical treatment of TOF is associated with good results in terms of control of acute symptoms and long-term outcome, particularly concerning oral intake and spontaneous breathing.

Keywords: Prolonged intubation; Tracheal anastomosis; Tracheal resection; Tracheo-oesophageal fistula.

MeSH terms

  • Adult
  • Anastomosis, Surgical
  • Esophagectomy
  • Esophagus / injuries
  • Esophagus / surgery*
  • Female
  • Humans
  • Intubation, Intratracheal
  • Male
  • Middle Aged
  • Postoperative Complications
  • Reconstructive Surgical Procedures / methods*
  • Retrospective Studies
  • Sternotomy
  • Trachea / injuries
  • Trachea / surgery*
  • Tracheoesophageal Fistula / surgery*
  • Tracheotomy
  • Treatment Outcome