Postintubation Tracheoesophageal Fistula - Diagnosis, Treatment and Prognosis

Abstract

RezumatIntroducere: Fistula esotraheală postintubaţie este o complicaţie severă, apărută în anumite condiţii la pacienţii care necesită ventilaţie mecanică pentru o perioadă îndelungată de timp. Material şi metodă: Articolul prezintă o serie de 11 pacienţi cu fistula esotraheală postintubaţie operaţi în clinica noastră în perioada 2005 -2015. Abordul anterior cu rezecţie de trahee a fost preferat la 10 dintre aceşti pacienţi, într-un caz cu o fistulă de dimensiuni mari preferând să efectuăm o intervenţie chirurgicală atipică. Trei dintre pacienţii seriei au fost operaţi înainte de sevrarea de ventilator în încercarea de a ajuta la desprinderea de ventilaţia mecanică. Două cazuri au fost operate în urma recidivei fistulei după tentative de închidere în alte servicii chirurgicale. Rezultate: Doi pacienţi (ambii din grupul celor care nu au fost sevraţi de ventilator) au decedat în urma unor complicaţii specifice intubaţiei continuate după rezecţia traheală (dehiscenţă anastomotică cu mediastinită şi fistulă traheo-vasculară în trunchiul arterial brahiocefalic). Restul de 9 pacienţi ai seriei au avut o evoluţie bună, cu restaurarea căii aeriene şi deglutiţie normală. Concluzii: Abordarea chirurgicală a acestei patologii are succes în servicii specializate în chirurgie traheală şi esofagiană. Alegerea momentului operator este de mare importanţă pentru obţinerea unor rezultate bune.Cuvinte cheie: fistula esotraheală, stenoză trahee, rezecţie traheală The anterior approach with tracheal resection was performed in 10 of these patients, while an atypical surgical technique was preferred in a case involving a large-sized fistula. Three of these patients were subject to surgery while still on the ventilator, in order to help weaning them from mechanical ventilation. Two patients were operated following a relapse of the fistula, after attempts of closing it in other surgical units. Results: Two patients (of those who were still on mechanical ventilation) died from intubation-related complications that persisted after tracheal resection (anastomotic dehiscence with mediastinitis and tracheoarterial fistula in the brachiocephalic arterial trunk). The nine remaining patients improved, with their airways restored and having regained normal deglutition. Conclusions: The surgical approach of this pathology is successful in surgical units that are specialised in tracheal and oesophageal surgery. Adequately timing the surgery is crucial for a good outcome.

Surgical Treatment Outcomes of Acquired Benign Tracheoesophageal Fistula: A Literature Review

“…In most cases, the esophagus is abandoned and the trachea is repaired first. The abandoned esophagus is reconstructed at 1 stage on the operation date or delayed reconstruction is performed using the stomach or colon several months later [ 6 , 8 , 9 , 16 - 18 ]. In the past, in surgery for large fistulas, muscle flap interposition was used for the treatment of acquired TEF.…”

“…Finally, we compared the morbidity and mortality discussed in the literature [ 1 , 6 - 18 ] ( Table 4 ). The comparison of clinical results of small centers to those of large centers was not significant because tracheal surgery was performed in <2 cases per year (range, 0.2–2.5 cases) at most institutions.…”

“…Moreover, the choice between the 2 surgical methods depended on institutional preferences, rather than specific inclusion criteria. The literature review indicated that primary repair and tracheal resection were performed in 42.9% and 43.2% of cases, respectively, and tracheal resection was preferred in 9 of 14 reports (Table 3) [1,[6][7][8][9][10][11][12][13][14][15][16][17][18].…”

Prolonged Intubation Induced Tracheoesophageal Fistula in Suspected Meningococcal Sepsis with ARDS: A Case Report

“…Acquired benign TEF is an uncommon complication; however, endotracheal intubation remains the most common cause with the incidence of <1%, first reported by D'Avignon (1956) and Mounier-Kuhn (1958). [1][2][3][4] A cough after swallowing is the chief presentation of TEF with or without other associated comorbidities such as pneumonia. Bronchoscopy, esophagogastroscopy, and computed tomography are the investigations of choice.…”

“…Early diagnosis and surgical correction have a better prognosis. 1,4,5 We are reporting a rare case diagnosed early on esophagogastroscopy before the complication such as pneumonia.…”