P. Macchiarini et al., Evaluation and outcome of different surgical techniques for postintubationtracheoesophageal fistulas, J THOR SURG, 119(2), 2000, pp. 268-274
Citations number
13
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective: We evaluated the outcome of different surgical techniques for po
stintubation tracheoesophageal fistula, Methods: Thirty-two consecutive pat
ients aged 51 +/- 23 years had tracheoesophageal fistulas resulting from a
median of 30 days of mechanical ventilation via endotracheal (n = 12) or tr
acheostomy (n = 20) tubes. Tracheoesophageal fistulas were 2.5 +/- 1.2 cm l
ong and were associated with a tracheal (n = 10) or subglottic (n = 3) sten
osis in 13 patients. Results: All But 3 patients were weaned from respirato
rs before: repair. All operations were done through cervical incisions and
included direct division and closure (n = 9), esophageal diversion (n = 3),
muscle interposition (n = 6), or, more recently, tracheal or laryngotrache
al resection and anastomosis with primary esophageal closure (n = 14), Nine
thyrohyoid and, two supralaryngeal releases reduced anastomotic tension, T
wenty-three patients (74%) were extubated after the operation (n = 16) or w
ithin 24 hours (n = 7), and 7 required a temporary tracheotomy tube. One po
stoperative death (3%) was associated with recurrent tracheoesophageal fist
ula, Seven complications (22%) included recurrent tracheoesophageal fistula
(n = 1), delayed tracheal stenosis (n = 2), dysphagia (n = 2), and recurre
nt nerve palsy (n = 2), Complications necessitated reoperation (n = 1), dil
ation (n = 2), definitive tracheostomy (n = 1), Montgomery T tubes (n = 1),
and Teflon injection of the vocal cords (n = 1). Twenty-nine patients (93%
) had excellent (n = 24) or good (n = 5) anatomic and functional long-term
results, Complications have been less common (7% vs 38%) and long-term resu
lts better (93% vs 65%) recently with tracheal or laryngotracheal resection
and anastomosis with primary: esophageal closure-as compared with previous
procedures. Conclusions: Post-intubation tracheoesophageal fistula is usua
lly best treated with tracheal or laryngotracheal resection and anastomosis
with primary esophageal closure even in the absence of tracheal damage.