Closure of tracheoesophageal fistula with two‐layer tracheal‐esophagoplasty and tracheal advancement

Hu, Amanda; Meratı, Albert L.; Meyer, Tanya K.

doi:10.1002/lary.23403

Cited by 6 publications

(7 citation statements)

References 19 publications

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“…25,32,38 Similarly, all the failed TEP closures presented in this review using the deltopectoral flaps were in patients who had previous adjuvant radiotherapy, which was likely the cause of wound breakdown and the susceptibility to infection. 32,38 Conversely, no TEP recurrence was reported in patients managed with a FFF or the lateral arm free flap despite 94% of patients having previous history of radiotherapy. 9,[24][25][26]33,52 Ten studies reported the size of the puncture diameter.…”

Section: Discussionmentioning

confidence: 92%

“…Seventeen studies reporting outcomes of 117 patients were included in the quantitative analysis. 9 11 25 28 30 32 33 35 38 40 44 46 47 48 49 52 The overall incidence of unsuccessful TEP closure was 6% (95% CI 1–13%) ( Fig. 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…1 ). 9 10 11 13 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 Using the OCEBM, 33 studies had a level of evidence of 4. No discrepancies during quality assessment occurred.…”

Section: Resultsmentioning

confidence: 99%

“…The authors reported complete fistula closure in four patients and one case of flap dehiscence, resulting probably because of its extended length and the slim base of the flap, which ultimately compromised the perfusion. 32,45 In this setting, the deltopectoral flap may not be the best alternative for a flap-based reconstruction for TEF closure as it yielded a 17% (95% CI < 1-64%) failure rate. Also, the use of bulky muscle flaps may compromise the airway and esophageal lumen and can lead to stomal stricture, potentially requiring further surgery in the form of stomaplasty.…”

Section: Discussionmentioning

confidence: 99%

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Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

et al. 2022

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Tracheoesophageal puncture (TEP) and voice prosthesis insertion following laryngectomy may fail to form an adequate seal. When spontaneous closure of the fistula tract does not occur after conservative measures, surgical closure is required. The purpose of this study was to summarize the available evidence on surgical methods for TEP site closure.A comprehensive search across PubMed, Web of Science, SCOPUS, and Cochrane was performed to identify studies describing surgical techniques, outcomes, and complications for TEP closure. We evaluated the rate of unsuccessful TEP closure after surgical management. A meta-analysis with a random-effect method was performed.Thirty-four studies reporting on 144 patients satisfied inclusion criteria. The overall incidence of an unsuccessful TEP surgical closure was 6% (95% confidence interval [CI] 1–13%). Subgroup analysis showed an unsuccessful TEP closure rate for silicone button of 8% (95% CI < 1–43%), 7% (95% CI < 1–34%) for dermal graft interposition, < 1% (95% CI < 1–37%) for radial forearm free flap, < 1% (95% CI < 1–52%) for ligation of the fistula, 17% (95% CI < 1–64%) for interposition of a deltopectoral flap, 9% (95% CI < 1–28%) for primary closure, and 2% (95% CI < 1–20%) for interposition of a sternocleidomastoid muscle flap.Critical assessment of the reconstructive modality should take into consideration previous history of surgery or radiotherapy. Nonirradiated fields and small defects may benefit from fistula excision and tracheal and esophageal multilayer closure. In cases of previous radiotherapy, local flaps or free tissue transfer yield high successful TEP closure rates. Depending on the defect size, sternocleidomastoid muscle flap or fasciocutaneous free flaps are optimal alternatives.

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Section: Discussionmentioning

confidence: 92%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

et al. 2022

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“…2 Several techniques have been described, usually with flap interposition, aiming to reduce the risk of fistula persistence. The multiple techniques published [1][2][3][4][5] lead us to the conclusion that there is no unanimity on this subject.…”

mentioning

confidence: 99%

Surgical Closure of Tracheoesophageal Puncture Without a Flap Interposition

Neves

Nobre

Portugal

et al. 2020

Otolaryngol.--head neck surg.

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Tracheoesophageal puncture for voice prosthesis placement is often used in vocal rehabilitation of patients undergoing total laryngectomy. Although its closure can occur spontaneously, some patients require a surgical procedure. We propose a surgical technique, without flap interposition, that begins with careful separation of the esophagus and trachea and identification of the site of tracheoesophageal fistula. After continuous suture closure of the esophagus, the anterior segment of the first tracheal rings is vertically incised to facilitate tracheal closure in a suture without tension. Finally, a small pectoral skin flap is made and mobilized to suture to the free edges of the sectioned tracheal rings, thus reducing the risk of tracheal stenosis. Four patients underwent this procedure with uneventful postoperative evolution and permanent closure of the fistula.

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Commentary on “Advancing tracheoesophageal fistula repair techniques: Suggestions for future research”

Lane,

Goyal

2024

American Journal of Otolaryngology

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Closure of tracheoesophageal fistula with two‐layer tracheal‐esophagoplasty and tracheal advancement

Cited by 6 publications

References 19 publications

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

Definitive Closure of the Tracheoesophageal Puncture Site after Oncologic Laryngectomy: A Systematic Review and Meta-Analysis

Surgical Closure of Tracheoesophageal Puncture Without a Flap Interposition

Commentary on “Advancing tracheoesophageal fistula repair techniques: Suggestions for future research”

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