Postintubation Tracheoesophageal Fistula - Diagnosis, Treatment and Prognosis

Implanting jejunostomy tube as conservative management of tracheoesophageal fistula in a COVID-19 patient

A 44-year-old woman with Behcet's disease experienced a severe COVID-19 infection and developed a tracheoesophageal fistula. Despite the need for surgical treatment, she did not consent. Therefore, the patient underwent supportive treatment with a jejunostomy tube. After four weeks of follow-up, the fistula was repaired spontaneously.

Surgical repair of mechanical ventilation induced tracheoesophageal fistula

PURPOSE

To evaluate the outcomes of surgery to repair tracheoesophageal fistula (TEF) caused by mechanical ventilation.

METHOD

Case series and review of all cases reported in English literature. Only reports of TEF following mechanical ventilation and containing description of surgical repair and outcomes were included.

RESULTS

A total of 41 studies comprising 143 patients met the inclusion criteria. Most studies had incomplete information on important variables such as co-morbidity and fistula size. Tracheal resection anastomosis (TRA) was the most common approach, performed in 91 (63.6%) patients (including three newly reported here). Lateral approach repair (LA) was done in 45 (31.5%) patients. The former had a higher incidence of pre-existing tracheal stenosis [53 (89.8%) vs. 7 (35%) cases; p < 0.001]. Flap interposition to augment the repair was done in 49 (53.9%) and 40 (88.9%) cases, respectively (p < 0.001). Successful and durable healing of the fistula were achieved in 90 (98.9%) cases in TRA and 39 (88.6%) cases in LA.

CONCLUSION

In carefully selected cases of TEF caused by mechanical ventilation, TRA is the most preferred approach, delivering successful healing in almost all cases. Where TRA is not indicated or preferred, LA appears to be a good alternative. Future studies should explicitly report all of the known co-variables, so that the exact indications for choosing a particular surgical approach could be better elucidated.