Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Feb;277(2):323-331.
doi: 10.1007/s00405-019-05723-y. Epub 2019 Nov 8.

Surgical repair of mechanical ventilation induced tracheoesophageal fistula

Muthuswamy Dhiwakar  1 , Ohad Ronen  2 , Mrinal Supriya  3 , Shivprakash Mehta  4
Affiliations
Review

Surgical repair of mechanical ventilation induced tracheoesophageal fistula

Muthuswamy Dhiwakar et al. Eur Arch Otorhinolaryngol. 2020 Feb.

Abstract

Purpose: To evaluate the outcomes of surgery to repair tracheoesophageal fistula (TEF) caused by mechanical ventilation.

Method: Case series and review of all cases reported in English literature. Only reports of TEF following mechanical ventilation and containing description of surgical repair and outcomes were included.

Results: A total of 41 studies comprising 143 patients met the inclusion criteria. Most studies had incomplete information on important variables such as co-morbidity and fistula size. Tracheal resection anastomosis (TRA) was the most common approach, performed in 91 (63.6%) patients (including three newly reported here). Lateral approach repair (LA) was done in 45 (31.5%) patients. The former had a higher incidence of pre-existing tracheal stenosis [53 (89.8%) vs. 7 (35%) cases; p < 0.001]. Flap interposition to augment the repair was done in 49 (53.9%) and 40 (88.9%) cases, respectively (p < 0.001). Successful and durable healing of the fistula were achieved in 90 (98.9%) cases in TRA and 39 (88.6%) cases in LA.

Conclusion: In carefully selected cases of TEF caused by mechanical ventilation, TRA is the most preferred approach, delivering successful healing in almost all cases. Where TRA is not indicated or preferred, LA appears to be a good alternative. Future studies should explicitly report all of the known co-variables, so that the exact indications for choosing a particular surgical approach could be better elucidated.

Keywords: Esophagus; Fistula; Surgery; Trachea; Ventilation.

PubMed Disclaimer

References

    1. Muniappan A, Wain JC, Wright CDM et al (2013) Surgical treatment of non-malignant tracheoesophageal fistula: a thirty-five year experience. Ann Thorac Surg 95(4):1141–1146 - PubMed
    1. Bibas BJ, Guerreiro Cardoso PF, Minamoto H et al (2016) Surgical management of benign acquired tracheoesophageal fistulas: a ten-year experience. Ann Thorac Surg 102(4):1081–1087 - PubMed
    1. Baisi A, Bonavina L, Narne S, Peracchia A (1999) Benign tracheoesophageal fistula: results of surgical therapy. Dis Esophagus 12(3):209–211 - PubMed
    1. Lefebvre C, Manheimer E, Glanville J (2011) Chapter 6: searching for studies. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration. https://www.handbook.cochrane.org .
    1. Macchiarini P, Verhoye JP, Chapelier A, Fadel E, Dartevelle P (2000) Evaluation and outcome of different surgical techniques for postintubation tracheoesophageal fistulas. J Thorac Cardiovasc Surg 119(2):268–276 - PubMed

LinkOut - more resources