Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy

• Published in: Diseases of the esophagus Vol. 37; no. 1
• Main Authors: de Groot, E M, Kingma, B F, Goense, L, van der Kaaij, N P, Meijer, R C A, Ramjankhan, F Z, Schellekens, P A A, Braithwaite, S A, Marsman, M, van der Heijden, J J, Ruurda, J P, van Hillegersberg, R
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01.01.2024
• Subjects: Anastomosis, Surgical - adverse effects; Anastomotic Leak - etiology; Anastomotic Leak - surgery; Animals; Cattle; Esophageal Neoplasms - etiology; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Esophagectomy - methods; Esophagus - surgery; Fistula - etiology; Fistula - surgery; Humans; Original; treatment; esophagectomy; tracheoesophageal fistula
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1093/dote/doad054

Abstract The aim of this study was to evaluate the surgical treatment of esophago-tracheobronchial fistulas (ETBFs) that occurred after esophagectomy with gastric conduit reconstruction in a tertiary referral center for esophageal surgery. All patients who underwent surgical repair for an ETBF after esophagectomy with gastric conduit reconstruction were included in a tertiary referral center. The primary outcome was successful recovery after surgical treatment for ETBF, defined as a patent airway at 90 days after the surgical fistula repair. Secondary outcomes were details on the clinical presentation, diagnostics, and postoperative course after fistula repair. Between 2007 and 2022, 14 patients who underwent surgical repair for an ETBF were included. Out of 14 patients, 9 had undergone esophagectomy with cervical anastomosis and 5 esophagectomy with intrathoracic anastomosis after which 13 patients had developed anastomotic leakage. Surgical treatment consisted of thoracotomy to cover the defect with a pericardial patch and intercostal flap in 11 patients, a patch without interposition of healthy tissue in 1 patient, and fistula repair via cervical incision with only a pectoral muscle flap in 2 patients. After surgical treatment, 12 patients recovered (86%). Mortality occurred in two patients (14%) due to multiple organ failure. This study evaluated the techniques and outcomes of surgical repair of ETBFs following esophagectomy with gastric conduit reconstruction in 14 patients. Treatment was successful in 12 patients (86%) and generally consisted of thoracotomy and coverage of the defect with a bovine pericardial patch followed by interposition with an intercostal muscle.