242REPAIR OF POST-INTUBATION TRACHEO-OESOPHAGEAL FISTULAS THROUGH THE LEFT PRE-STERNOCLEIDOMASTOID APPROACH: A RECENT CASE SERIES OF 13 PATIENTS

• Published in: Interactive cardiovascular and thoracic surgery Vol. 19; no. suppl_1; p. S72
• Main Authors: Foroulis, C.N.N., Nana, C., Kleontas, A., Tagarakis, G., Tossios, P., Anastasiadis, K.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01-10-2014
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivu276.242

Objectives: Post-intubation tracheo-oesophageal fistula (TOF) is a late complication of tracheotomy, while membranous trachea laceration during percutaneous dilational tracheostomy has recently been implicated in the formation of early post-tracheotomy TOF. Surgical repair is the only viable option for these patients and the technique of repair depends on a variety of factors.
Methods: Thirteen patients (mean age: 54.1 ± 12.6 years, male: 8) with post-intubation TOF were managed between 1997 and 2013. The diagnosis was always made through oesophagoscopy followed by endoscopic gastrostomy and bronchoscopy for repositioning of the tracheal tube just above the carina. Repair of the fistula was made in all patients through a left pre-sternocleidomastoid incision followed by dissection of the fistulous tract, suturing of oesophagus and trachea and interposition of the whole pedicled left sternocleidomastoid muscle between the two suture lines (Fig.).
Results: Five out of the 13 procedures were performed in mechanically ventilated patients; 3 patients died from septic complications during the postoperative period while fistula recurred in 1 of those 3 patients due to extensive inflammation of the tracheal wall. The remaining 8 patients underwent fistula repair after weaning from mechanical ventilation and the results of repair were excellent. The additional procedure of temporary T-tube insertion was obviated in 1 patient to manage extensive tracheomalacia.
Conclusion: The left pre-sternocleidomastoid incision is an excellent access for the repair of a post-intubation TOF avoiding tracheal resection. The interposition of the whole left pedicled sternocleidomastoid muscle between the suture lines of trachea and oesophagus prevents fistula recurrence and offers the best chance for cure.