Escobedo SE, Martínez AMA, Otero PA, Damián LE, Ortiz CLÁ, Lozano VYA, De LCLP, Alderete GMF, Mercado SLS

Language: Spanish
References: 5
Page: 11-14
PDF size: 224.14 Kb.

ABSTRACT

Tracheoesophageal fistula is a rare condition, often associated with synchronous orotracheal intubation and nasogastric tube. Clinical suspicion can occur in a patient with or without mechanical ventilatory support, with recurrent respiratory infections or manifestations such as Ono's sign. Confirmation of the fistula is by bronchoscopy and/or endoscopy, other studies may be useful for initial management and planning of surgical treatment, such as computed tomography. Once a fistula is identified, initial management involves controlling it, managing septic foci, improving nutritional status and, prior to surgery, attempting to wean from the mechanical ventilator. Surgical treatment can be performed with a cervical approach that may require partial sternotomy, depending on its location. The surgical technique involves tracheal opening, with resection of the stenosed rings, when these are present, the closure of the esophageal defect in two planes, interposition of a muscle flap, and tracheal plasty when required. It is recommended to systematize the preoperative management, the surgical technique and the postsurgical management, in order to reduce complications and have better results. With the experience obtained, we recommend performing an early preoperative gastrostomy and avoiding the use of esophageal stents

REFERENCES

1. Elser T, Frederick A, Penn E, Bolton W, Stephenson J, Ben-Or S. Benign tracheal esophageal fistula. Operative Techniques in Thoracic and Cardiovascular Surgery. 2020; 25(1): 27-41.

2. Hilgenberg AD, Grillo HC. Acquired nonmalignant tracheoesophageal fistula. J Thorac Cardiovasc Surg. 1983; 85(4): 492-498.

3. Muniappan A, Wain JC, Wright CD, Donahue DM, Gaissert H, Lanuti M et al. Surgical treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experience. Ann Thorac Surg. 2013; 95(4): 1141-1146.

4. Bolca C, Pavaloiu V, Fotache G, Dumitrescu M, Bobocea A, Alexe M et al. Postintubation tracheoesophageal fistula-diagnosis, treatment and prognosis. Chirurgia (Bucur). 2017; 112(6): 696-704.

5. Brindle EM, Gawande A. Managing COVID-19 in surgical systems. Ann Surg. 2020; 272(1): e1-2.