| Surgical treatment of benign tracheo-oesophageal fistulas with tracheal resection and oesophageal primary closure: is the muscle flap really necessary? | |
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MedLine Citation:
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PMID: 19800809 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: Nowadays, despite the advances of the low-pressure high-volume cuffs, post-intubation tracheo-oesophageal fistula (TEF) still poses a major challenge to thoracic surgeons. The original technique includes interposition of muscle flaps between suture lines to avoid recurrence. It is not clear if this manoeuvre is indispensable and, in fact, we and others have faced problems with it. Our aim is to present our experience with TEF management in a consecutive group with no muscle interposition. METHODS: From June 1992 to November 2007, we evaluated 14 patients presenting with TEF, with a mean age of 44 years (from 18 to 79 years). Thirteen patients had a prolonged intubation history. The remaining case was a 40-year-old male with congenital TEF. Three patients had been previously submitted to failed repairs in other institutions. Ten patients had associated tracheal stenosis, which was subglottic in three of them. Regarding surgical technique, in all cases, we performed a single-staged procedure, which consisted of tracheal resection and anastomosis with double-layer oesophageal closure. In none of our cases was a muscle flap interposed between suture lines. RESULTS: All operations were performed through a cervical incision; however, in one case, an extension with partial sternotomy was required. There was no operative mortality. Thirteen patients were extubated in the first 24h after the procedure, while one patient required 48 h of mechanical ventilation. Four complications were recorded: one each of pneumonia and left vocal cord paralysis and two small tracheal dehiscences managed with a T-tube and a tracheostomy tube. After discharge, three patients returned to their native cities and were lost to follow-up. The remaining 11 patients have been followed up by a mean of 32 months (from three to 108 months), with 10 presenting excellent and one good anatomic and functional results. CONCLUSIONS: The single-staged repair with tracheal resection and anastomosis with oesophageal closure provides good short- and mid-term results for TEF management. The interposition of a muscle flap between suture lines may not be crucial to prevent recurrence. |
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Authors:
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José Jesus Camargo; Tiago Noguchi Machuca; Spencer Marcantônio Camargo; Vivalde F Lobato; Carlos Remolina Medina |
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Publication Detail:
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Type: Evaluation Studies; Journal Article Date: 2009-10-02 |
Journal Detail:
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Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery Volume: 37 ISSN: 1873-734X ISO Abbreviation: Eur J Cardiothorac Surg Publication Date: 2010 Mar |
Date Detail:
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Created Date: 2010-02-22 Completed Date: 2011-01-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8804069 Medline TA: Eur J Cardiothorac Surg Country: Germany |
Other Details:
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Languages: eng Pagination: 576-80 Citation Subset: IM |
Copyright Information:
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Copyright (c) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved. |
Affiliation:
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R. São Francisco da California 222, Apartment 304, Higienopolis, Porto Alegre, Rio Grande do Sul, 90550-080, Brazil. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Aged Anastomosis, Surgical / methods Esophagus / surgery Female Follow-Up Studies Humans Intubation, Intratracheal Male Middle Aged Muscle, Skeletal / transplantation Reoperation / methods Surgical Flaps* Tracheal Stenosis / complications, surgery Tracheoesophageal Fistula / etiology, prevention & control, surgery* Treatment Outcome Unnecessary Procedures Young Adult |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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