Surgery for recurrent benign tracheoesophageal fistula

doi:https://doi.org/10.17116/hirurgia202602136

OBJECTIVE

To optimize diagnosis and treatment methods for recurrent TEF based on analysis of extensive clinical experience; to propose preventive strategies reducing postoperative complications.

MATERIAL AND METHODS

Treatment outcomes were analyzed in 115 patients with TEF between 2004 and 2023. Of these, 40 (34.8%) ones underwent redo surgeries after previous failed fistula closure. There were 69 surgical interventions including third-time surgeries in 7 patients with repeated recurrences. TEF associated with tracheal cicatricial stenosis (TCS) in 29 (48.3%) cases necessitated concomitant surgical approaches. Treatment method was determined by characteristics of previous interventions and clinical situation.

RESULTS

No mortality was recorded. The most common postoperative complications were purulent-inflammatory processes. Key risk factors for recurrence were TEF associated with TCS and persistent tracheostomy after tracheoplasty with T-tube. Redo surgical interventions, 3-fold attempts of fistula closure, led to complete recovery in some cases.

CONCLUSION

The study confirms feasibility of radical treatment for recurrent TEF, even in case of significant anatomical and functional alterations. Original strategies for prevention of recurrence and refined surgical indications enhance treatment efficacy. These data can be used to improve clinical guidelines aimed at reducing recurrence rates and achieving better long-term outcomes.

Keywords:

Tracheoesophageal fistula

recurrent tracheoesophageal fistula surgery

tracheal stenosis

tracheal stenting

aspiration pneumonia

complications of mechanical ventilation

Received:

22.02.2025

Accepted:

26.03.2025

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References:

Bibas BJ, Cardoso PFG, Minamoto H, Eloy-Pereira LP, Tamagno MFL, Terra RM, et al. Surgical management of benign acquired tracheoesophageal fistulas: a ten-year experience. Ann Thorac Surg. 2016;102(4):1081-1087. https://doi.org/10.1016/j.athoracsur.2016.04.029
Aworanti O, Awadalla S. Management of recurrent tracheoesophageal fistulas: a systematic review. Eur J Pediatr Surg. 2014;24(5):365-375. https://doi.org/10.1055/s-0034-1370780
Perera Louvier R, Benito Bernáldez C, Sánchez Gómez JF. Tracheoesophageal fistula due to prolonged mechanical ventilation. Arch Bronconeumol (Engl Ed). 2020;56(9):593. https://doi.org/10.1016/j.arbres.2019.06.002
Parshin VD, Rusakov MA, Parshin VV. Khirurgiya trakheopishchevodnogo svishcha. Moscow: Aldi Print; 2016. (In Russ.).
Meier JD, Sulman CG, Almond PS, Holinger LD. Endoscopic management of recurrent congenital tracheoesophageal fistula: a review of techniques and results. Int J Pediatr Otorhinolaryngol. 2007;71(5):691-697. https://doi.org/10.1016/j.ijporl.2007.02.022
Parshin VD, Porkhanov VA. Reconstructive surgery of the trachea. 2nd ed. Moscow: Aldi-Print; 2020. (In Russ.).
Casson AG, Bethune DC. Acquired tracheoesophageal fistula. In: Pearson FG, Cooper JD, Deslauriers J, et al., eds. Thoracic Surgery. 2nd ed. New York, NY: Elsevier Science; 2002:341-347.
Parshin VD, Vishnevskaya GA, Rusakov MA. et al. Tracheoesophageal fistulas: current state of the problem. Pirogov Russian Journal of Surgery. 2013;2:73-79. (In Russ.).
Toczewski K, Rygl M, Dzielendziak A, et al. Thoracoscopic repair of congenital isolated H-type tracheoesophageal fistula. J Pediatr Surg. 2021;56(8):1386-1388. https://doi.org/10.1016/j.jpedsurg.2020.08.024
Woo S, Lau S, Yoo E, Shaul D, Sydorak R. Thoracoscopic versus open repair of tracheoesophageal fistulas and rates of vocal cord paresis. J Pediatr Surg. 2015;50(12):2016-2018. https://doi.org/10.1016/j.jpedsurg.2015.08.021
Parshin VD, Ruchkin DV, Bazarov DV, Vishnevskaya GA, Levitskaya NN, Golovinsky SV. Disconnection of the tracheal fistula of the artificial esophagus in a patient after esophageal extirpation for squamous cell carcinoma. Pirogov Russian Journal of Surgery. 2008;10:68-70. (In Russ.).