Surgical strategies for benign acquired tracheoesophageal fistula

Abstract

OBJECTIVES Tracheo-oesophageal fistula (TEF) is characterized by abnormal connectivity between the posterior wall of the trachea or bronchus and the adjacent anterior wall of the oesophagus. Benign TEF can result in serious complications; however, there is currently no uniform standard to determine the appropriate surgical approach for repairing TEF. METHODS The PubMed database was used to search English literature associated with TEF from 1975 to October 2023. We employed Boolean operators and relevant keywords: “tracheoesophageal fistula”, “tracheal resection”, “fistula suture”, “fistula repair”, “fistula closure”, “flap”, “patch”, “bioabsorbable material”, “bioprosthetic material”, “acellular dermal matrix”, “AlloDerm”, “double patch”, “oesophageal exclusion”, “oesophageal diversion” to search literature. The evidence level of the literature was assessed based on the GRADE classification. RESULTS Nutritional support, no severe pulmonary infection, and weaning from mechanical ventilation were the three determinants for timing of operation. TEFs were classified into three levels: small TEF (<1cm), moderate TEF (≥1 but <5cm), and large TEF (≥5cm). Fistula repair or tracheal segmental resection was used for the small TEF with normal tracheal status. If the anastomosis cannot be finished directly after tracheal segmental resection, special types of tracheal resection, such as slide tracheoplasty, oblique resection and reconstruction, and autologous tissue flaps were preferred depending upon the site and size of the fistula. Oesophageal exclusion was applicable to refractory TEF or patients with poor conditions. CONCLUSIONS The review primarily summarizes the main surgical techniques employed to repair various acquired TEF, to provide references that may contribute to the treatment of TEF.