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Ann Thorac Surg. 2018 Dec;106(6):1640-1646. doi: 10.1016/j.athoracsur.2018.06.076. Epub 2018 Aug 29.

Surgical Management of Post-Esophagectomy Tracheo-Bronchial-Esophageal Fistula.

Author information

1
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts.
2
Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: amuniappan@partners.org.

Abstract

BACKGROUND:

Post-esophagectomy tracheo-bronchial-esophageal fistula (PETEF) most often develops after anastomotic disruption or gastric conduit necrosis. Ideal surgical management and outcomes for this complication are uncertain.

METHODS:

A retrospective review of 11 patients undergoing surgical repair of PETEF was performed.

RESULTS:

The median time between esophagectomy and surgical repair of PETEF was 61 days (range, 7 days to 28 years). Anastomotic leak or gastric conduit necrosis was responsible for PETEF in 6 patients (54.5%), whereas other causes were erosion of a tracheal appliance (n = 2), gastric conduit staple line erosion (n = 1), anastomotic stricture dilation (n = 1), and recurrent esophageal cancer (n = 1). Membranous airway defects were repaired primarily and buttressed with muscle or omental flaps in 8 patients (72.7%), whereas two (18.2%) were repaired with bio-prosthetic patches and one (9.1%) was repaired with a sleeve resection of the bronchus. Anastomotic and neo-esophageal conduit defects were repaired primarily in 3 patients (27.3%), whereas 7 patients (63.6%) underwent conduit take-down and esophageal or pharyngeal diversion, and 1 patient (9.1%) underwent simultaneous fistula repair and colon interposition. Two patients (18.2%) had recurrent fistulas, with 1 patient dying after second fistula closure and the other was discharged with no further attempt at repair. Three patients (27.3%) died postoperatively. Only 3 patients (27.3%) resumed an oral diet after fistula repair.

CONCLUSIONS:

Surgical treatment is effective for most patients undergoing operative repair of PETEF, notwithstanding a considerable risk of postoperative morbidity and death. Although fistula repair is life saving and prevents further respiratory deterioration, return to oral alimentation is not ensured.

[Indexed for MEDLINE]

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