Surgical management of large tracheoesophageal fistula in infants after button battery ingestion

• Published in: European journal of cardio-thoracic surgery Vol. 63; no. 3
• Main Authors: Avsar, Murat, Goecke, Tobias, Keil, Oliver, Koeditz, Harald, Schwerk, Nicolaus, Kuebler, Joachim F, Horke, Alexander, Warnecke, Gregor, Haverich, Axel, Ure, Benno, Zardo, Patrick
• Format: Journal Article
• Language: English
• Published: Germany 01.03.2023
• Subjects: Child; Eating; Humans; Infant; Retrospective Studies; Trachea - surgery; Tracheoesophageal Fistula - etiology; Tracheoesophageal Fistula - surgery; Extracorporeal membrane oxygenation; Pedicled m. latissimus dorsi flap; Tracheoesophageal fistula; Decellularized aortic homograft; Button battery ingestion
• ISSN: 1873-734X; 1873-734X
• DOI: 10.1093/ejcts/ezad070

In recent years, an increase in severe and even fatal outcomes related to oesophageal or airway button battery (BB) ingestion by infants and small children has been reported. Extensive tissue necrosis caused by lodged BB can lead to major complications, including tracheoesophageal fistula (TEF). In these instances, best treatment remains controversial. While small defects may warrant a conservative approach, surgery often remains inevitable in highly complex cases with large TEF. We present a series of small children that underwent successful surgical management by a multidisciplinary team in our institution. This is a retrospective analysis of n = 4 patients <18 months undergoing TEF repair from 2018 to 2021. Surgical repair under extracorporeal membrane oxygenation (ECMO) support was feasible in n = 4 patients by reconstructing the trachea with decellularized aortic homografts that were buttressed with pedicled latissimus dorsi muscle flaps. While direct oesophageal repair was feasible in 1 patient, 3 required esophagogastrostomy and secondary repair. The procedure was completed successfully in all 4 children with no mortality and acceptable morbidity. Tracheo-oesophageal repair after BB ingestion remains challenging and is associated with major morbidity. Bioprosthetic materials in conjunction with the interposition of vascularized tissue flaps between trachea and oesophagus appear to be a valid approach to manage severe cases.