Surgical Management of Benign Acquired Tracheoesophageal Fistulas: A Ten-Year Experience

• Published in: The Annals of thoracic surgery Vol. 102; no. 4; pp. 1081 - 1087
• Main Authors: Bibas, Benoit Jacques, MD, Guerreiro Cardoso, Paulo Francisco, MD, PhD, Minamoto, Helio, MD, PhD, Eloy-Pereira, Leandro Picheth, MD, Tamagno, Mauro Federico L., MD, Terra, Ricardo Mingarini, MD, PhD, Pêgo-Fernandes, Paulo Manoel, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-10-2016
• Subjects: Adolescent; Adult; Age Factors; Aged; Aged, 80 and over; Anastomosis, Surgical - methods; Biopsy, Needle; Brazil; Bronchoscopy - methods; Cardiothoracic Surgery; Cohort Studies; Esophagoscopy - methods; Esophagus - surgery; Female; Follow-Up Studies; Humans; Immunohistochemistry; Male; Middle Aged; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Factors; Surgery; Survival Rate; Thoracotomy - methods; Trachea - surgery; Tracheoesophageal Fistula - mortality; Tracheoesophageal Fistula - pathology; Tracheoesophageal Fistula - surgery; Treatment Outcome; Young Adult
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2016.04.029

Background Benign tracheoesophageal fistulas (TEFs) are rare, and surgical correction is the ideal method of treatment. The objective of this study was to evaluate the results of operative treatment of benign TEFs in patients from a tertiary referral center. Methods Retrospective study of patients with benign TEFs who were treated between January 2005 and December 2014. Preoperative evaluation included computed tomography of the chest, bronchoscopy, and upper endoscopy. Preoperative treatment included nutritional support by gastrostomy and treatment of lung infections. Surgical repair was done with tracheal resection and reconstruction, laryngotracheal resection, or membranous tracheal repair without resection. Esophageal management consisted of two-layer closure. Results Twenty patients (11 men) with mean age 48 ± 17 years were included. The most frequent cause was postintubation injury (n = 16; 80%). The median TEF length was 9 mm (interquartile range [IQR], 2 to 25 mm). The most commonly used surgical approaches were cervicotomy (n = 15; 75%) and cervicosternotomy (n = 3; 15%). Eleven patients required tracheal resection; median length was 3 cm (IQR, 3 to 5.5 cm). Seven patients (35%) required intraoperative tracheostomy. Complications occurred in 55% of patients. There was one dehiscence of the tracheal anastomosis, and one procedure-related death. Ninety-five percent of patients had complete closure of the TEF occurred in 95% of cases. Two patients had tracheal stenosis recurrence, and one patient had both TEF and tracheal stenosis recurrence. Two patients have indwelling silicone tracheal stents. Conclusions Surgical treatment of TEF is effective. Nonetheless, morbidity and mortality are not negligible, even when performed at a referral center and after appropriate preoperative evaluation.