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International Society For Minimally Invasive Cardiothoracic Surgery

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Surgical Management Of Acquired Benign Tracheoesophageal Fistula: Single Center Experience
Petrucio A. Sarmento1, Juliana P. Franceschini2, Ricardo S. Santos3.
1Universidade Federal da Paraíba, João Pessoa, Brazil, 2ProPulmão, São Paulo, Brazil, 3Hospital Cárdio Pulmonar, Salvador, Brazil.

BACKGROUND: Benign tracheoesophageal fistula (TEF) in adults is a rare condition and managing it appropriately is a clinical and technical challenge. The aim of this study was to retrospectively analyze patients’ clinical characteristics and the surgical correction used in closuring acute and chronic benign TEF. METHODS: The records of patients undergoing TEF repair between 1988 January and 2008 December were analyzed. Surgical repair was performed with tracheal resection and reconstruction, laryngotracheal resection, or membranous tracheal repair. Preoperative treatment of lung infections and nutritional support were done following the hospital protocols.
RESULTS: 36 patients (18 males, mean age 39.8±18.2) underwent surgical repair of TEF. Surgical approaches are shown in table 1. The most common causes of TEF, for both groups, were postintubation injury (n=20) and trauma (n=7). The most frequent symptom was bronchoaspiration (n=13). Cervical trachea was the most frequent TEF location (52.9% for acute TEF and 73.7% for chronic FTE). Acute postoperative complications comprised sepsis (n=4), hematoma (n=1), air leak to the stomach (n=1), Heinike's edema and right vocal fold paralysis (n=1), esophageal necrosis (n=1) and kidney failure (n=1). Post hospital discharge complications comprised tracheal stenosis (n=2), laryngomalacia (n=1), right voice nail paralysis (n=1), and sudden cardiorespiratory arrest (n=1). There were no intraoperative deaths. Perioperative mortality was higher in the surgical management of acute benign TEF (29.4%) and the most frequent cause of death was sepsis (80%).
CONCLUSIONS: The surgical technique used for definitive repair is feasible and can be considered as an option for repair of acute and chronic TEF.

Surgical approaches from the 36 patients with tracheoesophageal fistula
n (%)Acute TEFn=17n (%)Chronic TEFn=19n (%)
Kocher cervicotomy13 (76.5)17 (89.4)
Cervical sternotomy3 (17.6)1 (5.3)
Thoracotomy1 (5.9)1 (5.3)
Use of local muscle flaps4 (23.5)3 (15.8)
Tracheostomy11 (64.7)7 (36.8)
Esophagorraphy10 (58.8)13 (68.4)
Complications during hospitalization5 (29.4)3 (15.8)
Complications post hospital discharge2 (11.8)3 (15.8)
Perioperative mortality5 (29.4)2 (10.5)

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