1
|
Post-esophagectomy tracheobronchoesophageal fistula: management and results of a tertiary referral center. Updates Surg 2023; 75:435-449. [PMID: 35996059 DOI: 10.1007/s13304-022-01364-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 08/17/2022] [Indexed: 01/24/2023]
Abstract
A tracheobronchoesophageal fistula (TBEF) is a rare but life-threatening complication after esophagectomy. The existing literature on TBEF management is limited and many previous recommendations are contradictory. We aimed to describe our series of TBEF after esophagectomy and compare it with other reported series. Patients who developed a TBEF after esophagectomy were identified retrospectively. Baseline and intraoperative characteristics, postoperative and TBEF details, treatments for TBEF, and main outcomes are described. A univariate analysis was performed to compare some of the analyzed variables with the overall sample. Finally, our results are compared with the previously described series. Altogether, 16 patients with TBEF (3.11%) were analyzed from 514 patients who received esophagectomies between January 2014 and February 2020. As a first treatment attempt, 14 (87.5%) were treated with surgery, one was treated conservatively, and one was treated endoscopically. Surgery both at a first or second treatment attempt achieved a survival rate of 62.5% and oral intake at discharge of 43.75%. Six patients died during their hospital stay (37.5%). The presence of an anastomotic leak showed a strong association with TBEF development (100% vs. 19.7%; OR 1.163, 95% CI 1.080-1.253, p = 0.000). In our experience, surgical treatment as the first approach for TBEF associated with anastomotic leak after esophagectomy obtained good results. However, there is an urgent need to elaborate treatment guidelines based on international consensus.
Collapse
|
2
|
Zarogoulidis P, Tryfon S, Saroglou M, Matthaios D, Tsakiridis K, Huang H, Bai C, Hohenforst-Schmidt W, Hatzibougias D, Athanasiou E, Michalopoulou-Manoloutsiou E, Mpoukovinas I, Ioannidis A, Kosmidis C. Tracheal fistula repair with stent placement after failure of reconstruction with muscle tissue. A lung cancer surgery complication. Respir Med Case Rep 2021; 34:101518. [PMID: 34603953 PMCID: PMC8473540 DOI: 10.1016/j.rmcr.2021.101518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 09/10/2021] [Accepted: 09/20/2021] [Indexed: 11/24/2022] Open
Abstract
A report a case of a 63 year old male diagnosed with lung cancer adenocarcinoma. The patient had a right paratracheal mass diagnosed with EBUS-TBNA 22G. The patient had surgery, however 7 days after the billau catheter was removed pneumothorax was diagnosed which did not resolved. Bronchoscopy reveled two minor fistulas in the interior wall of the trachea. An additional surgery was performed in order to add muscle patches on the exterior part of the trachea. Unfortunately additional stent placement was placed after a silicon stent since the muscle patches failed. We chose a metallic auto expandable stent since after three months of follow up a small metastatic lesion was observed in the liver. Stent placement is an option for these patients and the right stent has to be placed for each case.
Collapse
Affiliation(s)
- Paul Zarogoulidis
- Pulmonary Department, "Bioclinic" Private Hospital, Thessaloniki, Greece
- 3rd University General Hospital, "AHEPA" University Hospital, Thessaloniki, Greece
- Corresponding author. 3rd University General Hospital, "AHEPA" University Hospital, Thessaloniki, Greece.
| | - Stavros Tryfon
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece
| | - Maria Saroglou
- Pulmonary Department, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Greece
| | | | - Kosmas Tsakiridis
- Thoracic Surgery Department, "Interbalkan" European Medical Center, Thessaloniki, Greece
| | - Haidong Huang
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Chong Bai
- Department of Respiratory & Critical Care Medicine, Changhai Hospital, The Second Military Medical University, Shanghai, China
| | - Wolfgang Hohenforst-Schmidt
- Sana Clinic Group Franken, Department of Cardiology / Pulmonology / Intensive Care / Nephrology, ’’Hof’’ Clinics, University of Erlangen, Hof, Germany
| | | | | | | | | | - Aris Ioannidis
- Surgery Department, "Genesis" Private Clinic, Thessaloniki, Greece
| | | |
Collapse
|
3
|
Esophageal bypass surgery as a definitive repair of recurrent acquired benign bronchoesophageal fistula. J Cardiothorac Surg 2019; 14:73. [PMID: 30971283 PMCID: PMC6458707 DOI: 10.1186/s13019-019-0902-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 04/01/2019] [Indexed: 11/10/2022] Open
Abstract
Background Acquired benign bronchoesophageal fistula (BEF) is rare and develops as a complication of other diseases, mostly of inflammatory processes and traumas of the chest. The treatment of choice is a surgical repair, which is considered definitive and leads to successful outcomes. However, incidence of recurrence after the primary repair based on limited data is up to 10% and its treatment is challenging. We report a surgical case of a patient with recurrent acquired benign BEF after primary resection and ensuing successful definitive repair with esophageal bypass surgery after temporary esophageal stenting. Case report A 46-year-old male was referred to our department with a symptomatic left-sided bronchoesophageal fistula as a complication of severe acute necrotizing mediastinitis that originated from odontogenic abscess. Previously, several cervicotomies and bilateral thoracotomy were performed at an external medical facility to manage the acute condition. We performed resection of the fistula through re-thoracotomy. Postprocedural esophagography demonstrated a recurrence of bronchoesophageal communication. Postinflammatory adhesions excluded further repair through thoracotomy, therefore a stent was introduced in the esophagus for 12 weeks. Thereafter, an esophageal bypass surgery using a substernaly interposed gastric conduit was performed and resulted in an excellent long-term outcome. Conclusions Esophageal bypass surgery using a substernaly interposed gastric conduit may be considered if the standard surgical repair of acquired benign bronchoesophageal fistula is not successful or feasible.
Collapse
|
4
|
Thakkar HS, Hewitt R, Cross K, Hannon E, De Bie F, Blackburn S, Eaton S, McLaren CA, Roebuck DJ, Elliott MJ, Curry JI, Muthialu N, De Coppi P. The multi-disciplinary management of complex congenital and acquired tracheo-oesophageal fistulae. Pediatr Surg Int 2019; 35:97-105. [PMID: 30392126 PMCID: PMC6325990 DOI: 10.1007/s00383-018-4380-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2018] [Indexed: 12/02/2022]
Abstract
AIM OF THE STUDY Complex tracheo-oesophageal fistulae (TOF) are rare congenital or acquired conditions in children. We discuss here a multidisciplinary (MDT) approach adopted over the past 5 years. METHODS We retrospectively collected data on all patients with recurrent or acquired TOF managed at a single institution. All cases were investigated with neck and thorax CT scan. Other investigations included flexible bronchoscopy and bronchogram (B&B), microlaryngobronchoscopy (MLB) and oesophagoscopy. All cases were subsequently discussed in an MDT meeting on an emergent basis if necessary. MAIN RESULTS 14 patients were referred during this study period of which half had a congenital aetiology and the other half were acquired. The latter included button battery ingestions (5/7) and iatrogenic injuries during oesophageal atresia (OA) repair. Surgical repair was performed on cardiac bypass in 3/7 cases of recurrent congenital fistulae and all cases of acquired fistulae. Post-operatively, 9/14 (64%) patients suffered complications including anastomotic leak (1), bilateral vocal cord paresis (1), further recurrence (1), and mortality (1). Ten patients continue to receive surgical input encompassing tracheal/oesophageal stents and dilatations. CONCLUSIONS MDT approach to complex cases is becoming increasingly common across all specialties and is important in making decisions in these difficult cases. The benefits include shared experience of rare cases and full access to multidisciplinary expertise.
Collapse
Affiliation(s)
- H. S. Thakkar
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - R. Hewitt
- Department of Otolaryngology, Great Ormond Street Hospital, London, UK ,Tracheal Team, Great Ormond Street Hospital, London, UK
| | - K. Cross
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - E. Hannon
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - F. De Bie
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK ,General Surgery Resident, KU Leuven, Leuven, Belgium
| | - S. Blackburn
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - S. Eaton
- Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - C. A. McLaren
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - D. J. Roebuck
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK ,Department of Radiology, Great Ormond Street Children’s Hospital, London, UK
| | - M. J. Elliott
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - J. I. Curry
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK
| | - N. Muthialu
- Tracheal Team, Great Ormond Street Hospital, London, UK ,Department of Cardiothoracic Surgery, Great Ormond Street Hospital, London, UK
| | - P. De Coppi
- Neonatal and Paediatric Surgery, Great Ormond Street Hospital, London, UK ,Tracheal Team, Great Ormond Street Hospital, London, UK ,Stem Cells and Regenerative Medicine Section, DBC, University College London, London, UK
| |
Collapse
|