Surgical closure of persistent tracheoesophageal fistulas by esophageal suturing and cranial transposition of the trachea

Abstract

Implantation of a tracheoesophageal voice prosthesis is the gold standard for voice rehabilitation after a total laryngectomy. The incidence of complications generally appears to be greater in patients who have received radiotherapy. 1,2 Periprosthetic leakage, which persists despite conservative treatment, necessitates surgical treatment. This generally creates a problem that is difficult to solve, especially in the case of patients who underwent radiotherapy, as evidenced by the many surgical approaches described in the literature. Besides local techniques, more elaborate procedures, such as the combination of local suturing with an interposition of local or distant pedicle flaps between the esophagus and trachea and closure by means of free microvascular flaps, have been published. 2-5 Cranial transposition of the trachea has been described in only one publication. 3 In the present report, our experiences with a two-layer inverting suture of the esophagus combined with a cranial transposition of the residual trachea to close refractory tracheoesophageal fistulas (TEFs) are described.