Stapled Repair of Benign Acquired Tracheoesophageal Fistula: Description of Novel Technique and Assessment of Outcomes.

Pottakkat Biju,Chandrasekar Sandip,Ram Prakash Gurram,Senthil Gnanasekaran,Raja Kalayarasan

doi:10.7759/cureus.9854

Abstract

Compared to less invasive measures, surgical repair is the most effective modality for managing benign acquired tracheoesophageal fistula (TEF). Traditionally, this involves dismantling of the fistula and suture repair of tracheal and esophageal defects using a lateral or direct approach. However, the best approach remains a subject of debate. We describe a novel and simple technique for dismantling a benign acquired TEF with the use of an endo-stapler and interposition with sternocleidomastoid (SCM) muscle flap. Eleven TEF patients underwent repair using this stapled repair technique. Retrospectively, the perioperative and long-term outcomes were assessed in these patients. There were no cases of procedure-related mortality or airway-related complications. Two patients developed transient vocal cord palsy and one developed esophageal leak. At a mean follow-up of 21.4 months, no fistula recurrence, dysphagia, or tracheal stenosis was observed. Hence stapled dismantling and SCM muscle interposition is a simple and safe technique for repair of benign acquired TEF.

Highlights

Acquired non-malignant tracheoesophageal fistula (TEF) is a rare condition but can have disastrous consequences if not addressed appropriately
Among factors that can contribute to mechanical ventilation (MV) induced TEF, cuff pressure was the most important [2]
We describe our novel surgical technique, a form of lateral approach for TEF repair with technical modification

Summary

Introduction

Acquired non-malignant tracheoesophageal fistula (TEF) is a rare condition but can have disastrous consequences if not addressed appropriately. While most commonly related to prolonged mechanical ventilation (MV), other etiologies, such as trauma and surgery, contribute to the development of this complication [1]. Among factors that can contribute to MV induced TEF, cuff pressure was the most important [2]. The use of high-volume low-pressure cuffs was not as detrimental as their counterparts (low volume high-pressure cuffs) in impeding tracheal mucosal blood flow and can potentially reduce the incidence of the complication. Still, such cuffs are not completely complication-free as they can be overinflated, compromising mucosal blood flow [3]

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