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      Outcome and safety of tailored surgical treatments of nonmalignant esophagotracheobronchial fistula: report of fourteen patients

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          Abstract

          Introduction

          Acquired benign esophageal tracheobronchial fistulae are clinically rare. In this paper, we summarize our experiences in surgical treatment of 14 consecutive patients with acquired benign esophageal tracheobronchial fistula.

          Methods

          This series included patients who underwent surgery between January 2002 and June 2015 at our institution. We retrieved and analyzed data on demographics, operative characteristics, and surgical outcome of the patients.

          Results

          Bronchofiberscopy revealed the membranous trachea openings of fistulae and gastroendoscopy further showed lesions in the anterolateral wall of the esophagus. Thoracotomy, division of the fistulous tract, and closure of the esophagus and trachea and other procedures were performed. All operations were uneventful, and there was no perioperative and postoperative complication or death. Symptoms disappeared after surgery in patients. The median length of hospital stay was 53 (range 31–270) days. The patients were followed up for a median of 33.5 (range 15–168) months. No recurrence was reported.

          Conclusion

          Our results suggest that acquired benign esophageal tracheobronchial fistulae have a broad spectrum of anatomic pathologies and exhibit markedly varied clinical manifestations, and a surgical approach tailored to the condition of individual patients is recommended.

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          Most cited references 20

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          Evaluation and outcome of different surgical techniques for postintubation tracheoesophageal fistulas.

          We evaluated the outcome of different surgical techniques for postintubation tracheoesophageal fistula. Thirty-two consecutive patients aged 51 +/- 23 years had tracheoesophageal fistulas resulting from a median of 30 days of mechanical ventilation via endotracheal (n = 12) or tracheostomy (n = 20) tubes. Tracheoesophageal fistulas were 2.5 +/- 1.2 cm long and were associated with a tracheal (n = 10) or subglottic (n = 3) stenosis in 13 patients. All but 3 patients were weaned from respirators 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 laryngotracheal resection and anastomosis with primary esophageal closure (n = 14). Nine thyrohyoid and two supralaryngeal releases reduced anastomotic tension. Twenty-three patients (74%) were extubated after the operation (n = 16) or within 24 hours (n = 7), and 7 required a temporary tracheotomy tube. One postoperative death (3%) was associated with recurrent tracheoesophageal fistula. Seven complications (22%) included recurrent tracheoesophageal fistula (n = 1), delayed tracheal stenosis (n = 2), dysphagia (n = 2), and recurrent nerve palsy (n = 2). Complications necessitated reoperation (n = 1), dilation (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 results better (93% vs 65%) recently with tracheal or laryngotracheal resection and anastomosis with primary esophageal closure as compared with previous procedures. Postintubation tracheoesophageal fistula is usually best treated with tracheal or laryngotracheal resection and anastomosis with primary esophageal closure even in the absence of tracheal damage.
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            Acquired benign esophagorespiratory fistula: report of 16 consecutive cases.

            Sixteen cases of acquired benign esophagorespiratory fistula were treated in a 20-year period. A delay in diagnosis was usual, and most patients were first seen with a pulmonary infection already developed. Contrast esophageal x-ray studies established the diagnosis in all patients. There were seven esophagotracheal and nine esophagobronchial fistulas. A fistula between the esophageal diverticulum and a bronchus considered to be of inflammatory origin developed in 7 patients. A fistula as the consequence of trauma developed in 9 patients, and these fistulas were situated at a higher level of the respiratory tree. All patients underwent surgical treatment; in 12 it was definitive, and in 4 temporary gastrostomy was performed to improve nutrition before definite repair. The definitive repair consisted of eventual diverticulectomy, division of the fistula, and suture of both esophageal and respiratory defects. Two patients required esophageal resection and later reconstruction with colon interposition. One patient died, creating an operative mortality of 8.3% in the definitive-repair group. The remaining 11 patients had a gratifying long-term result. There were two deaths in the gastrostomy group due to an extremely poor condition of patients and debilitating pulmonary infection. Early diagnosis of this rare condition is necessary if severe pulmonary complications are to be avoided. Early direct repair gives excellent results.
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              • Article: not found

              Surgical management of acquired nonmalignant tracheoesophageal and bronchoesophageal fistulae.

              Acquired nonmalignant fistulae between the airway and esophagus (tracheoesophageal fistulae [TEF]) are rare life-threatening conditions. Several management approaches have been proposed, while the optimal strategy remains controversial.
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                Author and article information

                Journal
                Ther Clin Risk Manag
                Ther Clin Risk Manag
                Therapeutics and Clinical Risk Management
                Therapeutics and Clinical Risk Management
                Dove Medical Press
                1176-6336
                1178-203X
                2017
                29 November 2017
                : 13
                : 1543-1549
                Affiliations
                Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
                Author notes
                Correspondence: Shanqing Li, Department of Thoracic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, No 1 ShuaiFuYuan Street, Dong Cheng District, Beijing 100730, China, Tel +86 106 915 2630, Email lishanqing1610@ 123456163.com
                Article
                tcrm-13-1543
                10.2147/TCRM.S146977
                5716302
                © 2017 Guo et al. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

                Categories
                Original Research

                Medicine

                esophageal tracheobronchial fistula, surgery, safety

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