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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2001 April;42(2):257-60

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgical management of acquired non-malignant tracheo-esophageal fistulas

Oliaro A., Rena O., Papalia E., Filosso P. L., Ruffini E., Pischedda F., Cavallo A., Maggi G.

From the Department of Thoracic Surgery S. Giovanni Battista Hospital University of Turin, Turin, Italy


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Background. The ­aim of ­this ­study ­was to eval­u­ate ­the ­results of ­one-­stage sur­gi­cal man­age­ment of ­acquired ­non-malig­nant tra­cheo-esoph­a­geal fis­tu­las (­TEF).
Methods. Six con­sec­u­tive ­patients, 2 ­men ­and 4 wom­en ­with ­median ­age of 65 (­range 34-71) ­years ­had tra­cheo-esoph­a­geal fis­tu­las result­ing ­from a ­median of 33 (­range 20-86) ­days of intu­ba­tion ­via ­oro-tra­cheal or trach­e­os­to­my ­tubes. Median ­TEF ­length ­was 2.6 (range 1.8-3.5) cm ­and ­the ­defect ­was asso­ciat­ed ­with a tra­cheal sten­o­sis ­near or imme­di­ate­ly ­below ­the sto­ma in 4 cas­es (66%). Tracheal resec­tion ­and anas­tom­o­sis ­with pri­mary esoph­a­geal clo­sure ­was car­ried ­out in 4 ­patients; ­direct clo­sure of ­the tra­cheal ­and esoph­a­geal ­defects ­with mus­cle ­flap inter­po­si­tion ­was per­formed in 2 ­patients: tra­cheal sto­ma ­was ­left in ­site ­because of ­the ­high ­risk of post­op­er­a­tive res­pir­a­to­ry insuf­fi­cien­cy relat­ed to chron­ic obstruc­tive pul­mo­nary dis­ease.
Results. All ­six ­patients ­had com­plete con­trol of ­the ­TEF. One per­i­op­er­a­tive ­death ­occurred on ­day 27 (16%) relat­ed to ­the recur­rence of endo­cra­ni­al bleed­ing. The 5 ­long-­term sur­vi­vors ­were rou­tine­ly sub­mit­ted to tra­cheo-bron­chos­cop­ic con­trol ­and ­only ­one (20%) ­revealed gran­u­la­tion tis­sue at ­the ­suture ­line requir­ing ­two con­sec­u­tive bron­chos­cop­ic remov­als.
Conclusions. Postintu­ba­tion trach­e­oe­soph­a­geal fis­tu­la is usu­al­ly ­best treat­ed ­with ­one-­stage sur­gi­cal pro­ce­dure: ­which pref­er­ably con­sists of tra­cheal resec­tion ­and anas­tom­o­sis ­and pri­mary esoph­a­geal clo­sure.

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