Combined free autologous auricular cartilage and fascia lata graft repair for a recurrent tracheoesophageal fistula

Sugiyama, Akihide; Urushihara, Naoto; Fukumoto, Koji; Fukuzawa, Hiroaki; Watanabe, Kentaro; Mitsunaga, Maki; Aoba, Takeshi; Park, Susam

doi:10.1007/s00383-012-3255-7

Cited by 12 publications

(7 citation statements)

References 14 publications

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“…The placement of viable tissue between the suture lines may help to prevent the further recurrence of TEF [5, 6, 9, 10]. Previous studies have described the use of the pericardium, pleura, intercostal flap, cervical muscle flap, cartilage, and lymph nodes for this purpose [5, 6, 9, 10]. The flap can be harvested from the same surgical site with its own blood supply.…”

Section: Discussionmentioning

confidence: 99%

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The use of a sternothyroid muscle flap to prevent the re-recurrence of a recurrent tracheoesophageal fistula found 10 years after the primary repair

et al. 2016

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Recurrent tracheoesophageal fistula (TEF) is still difficult to diagnose and repair. In almost all cases, recurrence appears relatively soon after the primary surgery. We herein describe a case of recurrent TEF that appeared 10 years after the primary repair. At 2 years of age, the patient suffered from mental retardation due to encephalitis and developed a hiatus hernia with gastro-esophageal reflux. He underwent the repair of a hiatus hernia and fundoplication at 3 years of age. However, the hiatus hernia recurred 6 months after the operation. The patient suffered from recurrent pneumonia for 6 years after the appearance of the recurrent hiatus hernia. At 9 years of age, he was hospitalized frequently due to recurrent severe pneumonia. After admission at 9 years of age, an endoscopic study under general anesthesia was performed and revealed subglottic stenosis and a dilated esophagus with a recurrent hiatus hernia. Tracheotomy or laryngotracheal separation was first planned in order to improve his upper airway and facilitate the safer repair of the recurrent hiatus hernia. After laryngotracheal separation, the patient still suffered from severe pneumonia. In addition, a small volume of nutritional supplement was aspirated from the tracheostomy. Thus, recurrent TEF was suspected. Tests using dye under both esophagoscopy and bronchoscopy confirmed recurrent TEF. The fistula recurred in the cervical area because of the elevation of the esophagus due to the recurrent hiatus hernia. The fistula was surgically closed, with a sternothyroid muscle flap to prevent re-recurrence. At 4 months after this operation, the recurrent hiatus hernia was repaired. Thereafter, the patient’s respiratory symptoms showed a dramatic improvement. The patient is now doing well and free from further recurrences of TEF and hiatus hernia at 2 years after the final operation.

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Section: Discussionmentioning

confidence: 99%

“…Several authors have reported the effects of the interposition of viable tissue, as a flap, between the suture lines of the trachea and esophagus to prevent further recurrence in patients with recurrent TEF [9, 10]. We experienced a rare case in which a TEF recurred in the cervical area on the 10th year after the primary repair.…”

Section: Introductionmentioning

confidence: 99%

The use of a sternothyroid muscle flap to prevent the re-recurrence of a recurrent tracheoesophageal fistula found 10 years after the primary repair

et al. 2016

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“…Moreover, costal cartilage graft could also be used especially in cases that were experienced tracheal injury in the initial surgery (25). The other rarely used are omental flap (26) and combination of free auricular and fascia lata graft (27). There is no literature data supporting one tissue in preventing fistula recurrence.…”

Section: Management Of Rectefmentioning

confidence: 99%

Tracheoesophageal fistula after esophageal atresia repair: recurrent, missed or acquired

Boybeyi¹,

Soyer²

2022

Curr Chall Thorac Surg

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Esophageal atresia (EA) is a common congenital anomaly of pediatric surgical practice.Tracheoesophageal fistula (TEF) is defined as congenital fistulous connection between esophagus and airway.All newborns with EA need immediate surgical repair of this anomaly. As the survival has reached to 95%, the long-term consequences of TEF have become the focus of interest. The main complications of EA repair are classified as early complications including anastomotic leak, stricture, recurrent TEF (recTEF) and late complications including gastroesophageal reflux, esophageal dysmotility, tracheomalacia and respiratory disorders. TEFs seen after EA repair are the most challenging complication for both patient and the surgeon. These fistulas can occur after EA repair because of the recanalization of ligated original TEF called recTEF, a de novo fistula with different location called acquired TEF (acqTEF) or a second congenital fistula missed at the primary surgery called missed TEF (mTEF). Overall, incidence of fistula recurrence is between 5-10%. The well-described risk factors for TEF recurrences are inadequate ligation of original TEF, anastomotic complications including leak, stricture and ischemia, tracheal injuries at the primary repair, and juxtapositioning of esophageal and tracheal suture lines. The clinical presentation of all types of fistulas is similar. Thus, the diagnosis of all these fistulas is challenging. Even, all patients having coughing, chocking or recurrent respiratory tract infections after EA repair should be investigated for the presence of TEF recurrence. In addition, the management of each type of fistula requires different approaches and can be technically demanding for most cases. Although surgical management is mostly inevitable in the management of recTEF, medical observation may be a choice for the management of acqTEFs since there is a possibility of spontaneous healing. Despite the advanced surgical technique, the risk for secondary recurrences, increased morbidity and even mortality are still exists. Therefore, this review will focus on all of the aspects of TEFs seen after EA repair.

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“…Free autologous auricular and costal cartilage grafts have been used to close large tracheal defects that have resulted from division of rTEFs. 41,42 If adequate repair of the fistula and esophagus is not possible secondary to inflammation and inadequate tissue, esophageal replacement may be necessary.…”

Section: Open Surgical Therapiesmentioning

confidence: 99%

Recurrent Tracheoesophageal Fistula

Lal

Oldham

2013

Eur J Pediatr Surg

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Repair of recurrent tracheoesophageal fistulas (rTEFs) remains a technically challenging endeavor. Although considered the gold standard, open surgical repair is associated with significant morbidity and rates of recurrence. Over the last 40 years, endoscopic techniques have gained popularity and been touted as a safer first line treatment. This review complies the published articles related to endoscopic repair of rTEFs and reports the various techniques, number of interventions, and success rates. Controversy will remain as to which technique is superior until prospective, multi-institutional studies are performed.

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Combined free autologous auricular cartilage and fascia lata graft repair for a recurrent tracheoesophageal fistula

Cited by 12 publications

References 14 publications

The use of a sternothyroid muscle flap to prevent the re-recurrence of a recurrent tracheoesophageal fistula found 10 years after the primary repair

The use of a sternothyroid muscle flap to prevent the re-recurrence of a recurrent tracheoesophageal fistula found 10 years after the primary repair

Tracheoesophageal fistula after esophageal atresia repair: recurrent, missed or acquired

Recurrent Tracheoesophageal Fistula

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