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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

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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