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
. 2024 Jan 1;37(1):doad054.
doi: 10.1093/dote/doad054.

Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy

E M de Groot  1 , B F Kingma  1 , L Goense  1 , N P van der Kaaij  2 , R C A Meijer  2 , F Z Ramjankhan  2 , P A A Schellekens  3 , S A Braithwaite  4 , M Marsman  4 , J J van der Heijden  5 , J P Ruurda  1 , R van Hillegersberg  1
Affiliations

Surgical treatment of esophago-tracheobronchial fistulas after esophagectomy

E M de Groot et al. Dis Esophagus. .

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.

Keywords: esophagectomy; tracheoesophageal fistula; treatment.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
An esophago-tracheobronchial fistula in a patient with a large defect ( dotted line) in the trachea ( line) after the gastric conduit was removed (a). Esophago-tracheobronchial fistula repair with a bovine patch that was attached by a running suture (b).
Fig. 2
Fig. 2
Harvest of an intercostal muscle flap to cover the patch on the esophago-tracheobronchial fistula during thoracotomy. The intercostal flap is marked with a *.
Fig. 3
Fig. 3
A CT-scan of a patient with an esophago-tracheobronchial fistula with a stent in the gastric conduit and patent airway in (a) and a visible defect in the trachea on (b) which was also observed during bronchoscopy (c). The arrow is pointing to the esophago-tracheobronchial fistula.
Fig. 4
Fig. 4
Evaluation of the management of 14 patients with an esophagobronchial fistula developed after esophagectomy with gastric conduit reconstruction.
See this image and copyright information in PMC

References

    1. Sato Y, Tanaka Y, Suetsugu T et al. Three-step operation for esophago-left bronchial fistula with respiratory failure after esophagectomy: a case report with literature review. BMC Gastroenterol 2021; 21: 1–6. - PMC - PubMed
    1. Yasuda T, Sugimura K, Yamasaki M et al. Ten cases of gastro-tracheobronchial fistula: a serious complication after esophagectomy and reconstruction using posterior mediastinal gastric tube. Dis Esophagus 2012; 25: 687–93. 10.1111/j.1442-2050.2011.01309.x. - DOI - PubMed
    1. Schweigert M, Dubecz A, Beron M, Muschweck H, Stein H J. Management of anastomotic leakage-induced tracheobronchial fistula following oesophagectomy: the role of endoscopic stent insertion. Eur J Cardio Thorac Surg 2012; 41: e74–80. 10.1093/ejcts/ezr328. - DOI - PubMed
    1. Z B, Z T, Y H et al. The clinical characteristics, treatments and prognosis of post-esophagectomy airway fistula: a multicenter cohort study. Transl Lung Cancer Res 2022; 11: 331–41. 10.21037/tlcr-22-141. - DOI - PMC - PubMed
    1. Li Y, Wang Y, Chen J et al. Management of thoracogastric airway fistula after esophagectomy for esophageal cancer: a systematic literature review. J Int Med Res 2020; 48: 030006052092602. 10.1177/0300060520926025. - DOI - PMC - PubMed