Surgical management of large tracheoesophageal fistula in infants after button battery ingestion

Abstract

Objective In recent years an increase in severe and even fatal outcomes related to esophageal or airway button battery (BB) ingestion by infants and small children has been reported. Extensive tissue necrosis caused by lodged BB can lead to major complications, including tracheoesophageal fistula (TEF). In these instances best treatment remains controversial. While small defects may warrant a conservative approach, surgery often remains inevitable in highly complex cases with large TEF. We present a series of small children that underwent successful surgical management by a multidisciplinary team in our institution. Methods Retrospective analysis of n = 4 patients < 18 months undergoing TEF-repair from 2018-2021. Results Surgical repair under extracorporeal membrane oxygenation (ECMO) support was feasible in n = 4 patients by reconstructing the trachea with decellularized aortic homografts that were buttressed with pedicled latissimus dorsi muscle flaps. While direct esophageal repair was feasible in one patient, 3 required esophagogastrostomy and secondary repair. The procedure was completed successfully in all 4 children with no mortality and acceptable morbidity. Conclusion Tracheoesophageal repair after button battery ingestion remains challenging, and is associated with major morbidity. Bioprosthetic materials in conjunction with interposition of vascularized tissue flaps between trachea and esophagus appear to be a valid approach to manage severe cases.

Authors’ response to ‘enhancing decellularized aortic allografts for paediatric aortic valve replacement: insights and future directions’

“…With respect to the potential of decellularized aortic allografts for the treatment of tracheal injuries or malformations, we want to point to our recent publication in the EJCTS on the surgical management of large tracheoesophageal fistula after button battery ingestion in infants [ 4 ]. Meanwhile, we have successfully treated 6 children with decellularized aortic allogenic patch closure of the trachea in life-threatening conditions using extracorporeal membrane oxygenization.…”