Omental Flap Provides Definitive Management for Pediatric Patient With Multiple Tracheoesophageal Fistula Recurrences

Mangat, Sabrina; Haithcock, Benjamin E.; McLean, Sean E.

doi:10.1177/0003134820933609

Cited by 2 publications

(3 citation statements)

References 4 publications

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“…RTEF is commonly repaired by interposing a vascularized flap between the TEF repair site and the esophagus. Such vascularized flaps include the pericardium, pleura (5, 7), omentum (10), and muscles, such A contrast examination of the esophagus shows the third RTEF at the exact location of the first and second RTEFs (arrowhead). RTEF, recurrent tracheoesophageal fistula.…”

Section: Discussionmentioning

confidence: 99%

“…RTEF is commonly repaired by interposing a vascularized flap between the TEF repair site and the esophagus. Such vascularized flaps include the pericardium, pleura ( 5 , 7 ), omentum ( 10 ), and muscles, such as intercostal ( 11 ), latissimus dorsi ( 12 ), and sternothyroid ( 13 ) muscles. The pleural patch ( 5 , 7 ) and fascia lata graft ( 14 ) are useful for RTEF; however, in hindsight, a vascularized flap could have been more effective for the second RTEF in this case.…”

Section: Discussionmentioning

confidence: 99%

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Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report

et al. 2022

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A tracheoesophageal fistula (TEF) recurs in approximately 2%–13% of cases of esophageal atresia with TEF that are treated surgically. Currently, there is no consensus on the most effective treatment to prevent recurrent TEF (RTEF). Herein, we present a patient with type C esophageal atresia who underwent thoracoscopic esophago-esophageal anastomosis and TEF repair at 2 days old. However, RTEFs were observed at ages 3, 6, and 11 months, and thoracoscopic TEF repairs using a pleural patch, fascia lata graft, and pectoralis major myocutaneous (PMMC) flap were performed, respectively. A fourth recurrence led to mediastinitis, shock liver, disseminated intravascular coagulopathy, and a compromised respiratory status. Hence, laparoscopic esophageal transection was first performed to improve the respiratory condition by preventing the regurgitation of gastric contents. Once the patient was stable, a subtotal esophageal resection with TEF closure followed by gastric tube reconstruction was performed. In conclusion, we encountered a case of refractory RTEF that was repaired four times using various techniques, including a fascia lata graft and PMMC flap. However, TEF still recurred after these four operations. The final surgical strategy involved an esophageal transection as a palliative therapy, which improved the respiratory condition, followed by closure of the TEF and subtotal esophageal resection. Finally, esophageal reconstruction using a gastric tube after the complete remission of inflammation was effective. This multi-stage surgery was considered the only choice to rescue the patient and effectively prevent another recurrence.

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Section: Discussionmentioning

confidence: 99%

“…RTEF is commonly repaired by interposing a vascularized flap between the TEF repair site and the esophagus. Such vascularized flaps include the pericardium, pleura ( 5 , 7 ), omentum ( 10 ), and muscles, such as intercostal ( 11 ), latissimus dorsi ( 12 ), and sternothyroid ( 13 ) muscles. The pleural patch ( 5 , 7 ) and fascia lata graft ( 14 ) are useful for RTEF; however, in hindsight, a vascularized flap could have been more effective for the second RTEF in this case.…”

Section: Discussionmentioning

confidence: 99%

Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report

et al. 2022

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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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Omental Flap Provides Definitive Management for Pediatric Patient With Multiple Tracheoesophageal Fistula Recurrences

Cited by 2 publications

References 4 publications

Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report

Refractory tracheoesophageal fistula treated using multi-stage surgery: A case report

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

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