Skip to main content
SpringerLink
Log in

Surgical repair of mechanical ventilation induced tracheoesophageal fistula

  • Review Article
  • Published:
European Archives of Oto-Rhino-Laryngology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate the outcomes of surgery to repair tracheoesophageal fistula (TEF) caused by mechanical ventilation.

Method

Case series and review of all cases reported in English literature. Only reports of TEF following mechanical ventilation and containing description of surgical repair and outcomes were included.

Results

A total of 41 studies comprising 143 patients met the inclusion criteria. Most studies had incomplete information on important variables such as co-morbidity and fistula size. Tracheal resection anastomosis (TRA) was the most common approach, performed in 91 (63.6%) patients (including three newly reported here). Lateral approach repair (LA) was done in 45 (31.5%) patients. The former had a higher incidence of pre-existing tracheal stenosis [53 (89.8%) vs. 7 (35%) cases; p < 0.001]. Flap interposition to augment the repair was done in 49 (53.9%) and 40 (88.9%) cases, respectively (p < 0.001). Successful and durable healing of the fistula were achieved in 90 (98.9%) cases in TRA and 39 (88.6%) cases in LA.

Conclusion

In carefully selected cases of TEF caused by mechanical ventilation, TRA is the most preferred approach, delivering successful healing in almost all cases. Where TRA is not indicated or preferred, LA appears to be a good alternative. Future studies should explicitly report all of the known co-variables, so that the exact indications for choosing a particular surgical approach could be better elucidated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Muniappan A, Wain JC, Wright CDM et al (2013) Surgical treatment of non-malignant tracheoesophageal fistula: a thirty-five year experience. Ann Thorac Surg 95(4):1141–1146

    PubMed  Google Scholar 

  2. Bibas BJ, Guerreiro Cardoso PF, Minamoto H et al (2016) Surgical management of benign acquired tracheoesophageal fistulas: a ten-year experience. Ann Thorac Surg 102(4):1081–1087

    PubMed  Google Scholar 

  3. Baisi A, Bonavina L, Narne S, Peracchia A (1999) Benign tracheoesophageal fistula: results of surgical therapy. Dis Esophagus 12(3):209–211

    CAS  PubMed  Google Scholar 

  4. Lefebvre C, Manheimer E, Glanville J (2011) Chapter 6: searching for studies. In: Higgins JPT, Green S (eds) Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]. The Cochrane Collaboration. https://www.handbook.cochrane.org.

  5. Macchiarini P, Verhoye JP, Chapelier A, Fadel E, Dartevelle P (2000) Evaluation and outcome of different surgical techniques for postintubation tracheoesophageal fistulas. J Thorac Cardiovasc Surg 119(2):268–276

    CAS  PubMed  Google Scholar 

  6. Santini P, Dragotto A, Gigli PM et al (1998) Postintubation tracheoesophageal fistula: surgical treatment of three cases. J Thorac Cardiovasc Surg 116(3):518–519

    CAS  PubMed  Google Scholar 

  7. Pisanu A, Reccia I, Nieddu R, Uccheddu A (2009) Sternohyoid muscle flap interposition in the treatment of an acquired tracheoesophageal fistula. Head Neck 31(7):962–967

    PubMed  Google Scholar 

  8. Singhal SK, Virk RS, Dass A, Sandhu BS (2006) Tracheoesophageal fistula: new option in managemen. Indian J Otolaryngol Head Neck Surg 58(3):300–302

    PubMed  PubMed Central  Google Scholar 

  9. Mooty RC, Rath P, Self M, Dunn E, Mangram A (2007) Review of tracheo-esophageal fistula associated with endotracheal intubation. J Surg Educ 64(4):237–240

    PubMed  Google Scholar 

  10. Sikka K, Singh CA, Agrawal R, Kumar R, Thakar A, Sharma SC (2018) Acquired non-malignant cervical trachea-esophageal fistula: a case series. Indian J Otolaryngol Head Neck Surg. https://doi.org/10.1007/s12070-018-1281-z

    Article  PubMed  Google Scholar 

  11. Puma F, Vannucci J, Santoprete S et al (2017) Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis. J Thorac Dis 9(2):278–286

    PubMed  PubMed Central  Google Scholar 

  12. Shaari CM, Biller HF (1996) Staged repair of cervical tracheoesophageal fistulae. Laryngoscope 106(11):1398–1402

    CAS  PubMed  Google Scholar 

  13. Wolf M, Yellin A, Talmi YP, Segal E, Faibel M, Kronenberg J (2000) Acquired tracheoesophageal fistula in critically ill patients. Ann Otol Rhinol Laryngol 109(8 Pt 1):731–735

    CAS  PubMed  Google Scholar 

  14. Bardini R, Radicchi V, Parimbelli P, Tosato SM, Narne S (2003) Repair of a recurrent benign tracheoesophageal fistula with a Gore-Tex membrane. Ann Thorac Surg 76(1):304–306

    PubMed  Google Scholar 

  15. Camargo JJ, Machuca TN, Camargo SM, Lobato VF, Medina CR (2010) Surgical treatment of benign tracheo-oesophageal fistulas with tracheal resection and oesophageal primary closure: is the muscle flap really necessary? Eur J Cardiothorac Surg 37(3):576–580

    PubMed  Google Scholar 

  16. Sethi P, Bhatia PK, Biyani G, Paliwal B, Sharma V (2015) Acquired tracheo-oesophageal fistula: a challenging complication of tracheostomy. J Coll Physicians Surg Pak 25(Suppl 2):S76–77

    PubMed  Google Scholar 

  17. Abi Ghanem M, Azar E, Abu Khalil B (2011) Acquired non-malignant tracheoesophageal fistula. J Med Liban 59(3):162–164

    PubMed  Google Scholar 

  18. Golash V (2006) Single-stage repair of a large acquired tracheoesophageal fistula with interposition of 2 muscle pedicle flaps and laparoscopic gastrojejunostomy. J Thorac Cardiovasc Surg 131(6):1413–1414

    PubMed  Google Scholar 

  19. Athanassiadi K, Gerazounis M (2005) Repair of postintubation tracheoesophageal fistula in polytrauma patients. Injury 36(8):897–899

    PubMed  Google Scholar 

  20. Oliaro A, Rena O, Papalia EF et al (2001) Surgical management of acquired non-malignant trachea-esophageal fistulas. J Cardiovasc Surg (Torino) 42(2):257–260

    CAS  Google Scholar 

  21. Kakhki AD, Sheikhi K, Saghebi SR et al (2017) Post-intubation tracheoesophageal fistula: a nine-year experience. J Cardiothorac Med 5(3):177–180

    Google Scholar 

  22. Selvarathinam P, Rajasekar JS, Prabhakaran R et al (2015) Post intubation tracheo esophageal fistulae—critical analysis of its presentation and surgical management. Int J Biol Med Res 6(3):5058–5064

    Google Scholar 

  23. Kostadinov D, Stanchev S, Astroukov E et al (1998) Tracheoesophageal fistula and tracheal stenosis after long-term mechanical ventilation: diagnosis, treatment and prognosis. J Bronchol 5(1):39–42

    Google Scholar 

  24. Camilleri AE (1990) Management of acquired tracheo-esophageal fistula following intubation. J Laryngol Otol 104(3):267–269

    CAS  PubMed  Google Scholar 

  25. Fiala P, Cernohorsky S, Cermak J, Patek J, Krepela E, Mouckova M (2004) Tracheal stenosis complicated with tracheoesophageal fistula. Eur J Cardiothorac Surg 25(1):127–130

    CAS  PubMed  Google Scholar 

  26. Davari HR, Latifi S (2014) Successful airway management in a patient with tracheal stenosis and tracheoesophageal fistula: a case report. Acta Med Iran 52(7):565–568

    PubMed  Google Scholar 

  27. Bugge-Asperheim B, Birkeland S, Storen G (1981) Tracheo-oesophageal fistula caused by cuffed tracheal tubes. Scand J Thorac Cardiovasc Surg 15(3):315–319

    CAS  PubMed  Google Scholar 

  28. Bolca C, Pavaloiu V, Fotache G et al (2017) Postintubation tracheoesophageal fistula—diagnosis, treatment and prognosis. Chirurgia (Bucur) 112(6):696–704

    Google Scholar 

  29. Lee JE, Chang MY, Kim KH, Jung YH (2011) Post-intubation tracheoesophageal fistula with posterior glottic web. Clin Exp Otorhinolaryngol 4(2):105–108

    PubMed  PubMed Central  Google Scholar 

  30. Geha AS, Seegers JV, Kodner IJ, Lefrak S (1978) Tracheoesophageal fistula caused by cuffed tracheal tube. Successful treatment by tracheal resection and primary repair with four-year follow-up. Arch Surg 113(3):338–340

    CAS  PubMed  Google Scholar 

  31. Liu J, Wu W, Liu S, Xu Z, Wang J, Li B (2017) A modified tracheal transaction approach for the repair of nonmalignant tracheoesophageal fistulas: a report of 5 cases. ORL J Otorhinolaryngol Relat Spec 79(3):147–152

    PubMed  Google Scholar 

  32. Pelc P, Prigogine T, Bisschop P, Jortay A (2001) Tracheoesophageal fistula: case report and review of literature. Acta Otorhinolaryngol Belg 55(4):273–278

    CAS  PubMed  Google Scholar 

  33. Thomas AN (1972) Management of tracheoesophageal fistula caused by cuffed tracheal tubes. Am J Surg 124(2):181–189

    CAS  PubMed  Google Scholar 

  34. Li Z, Zhong C (2014) Montgomery T-tube for the management of postintubation tracheoesophageal fistula with synchronic subglottic laryngotracheal stenosis. Thorac Cardiovasc Surg Rep 3(1):61–63

    CAS  PubMed  PubMed Central  Google Scholar 

  35. Akaraviputh T, Angkurawaranon C, Phanchaipetch T et al (2014) Platysma myocutaneous flap interposition in surgical management of large acquired post-traumatic tracheoesophageal fistula: a case report. Int J Surg Case Rep 5(5):282–286

    PubMed  PubMed Central  Google Scholar 

  36. Su JW, Mason DP, Murthy SC, Rice TW (2008) Closure of a large tracheoesophageal fistula using AlloDerm. J Thorac Cardiovasc Surg 135(3):706–707

    PubMed  Google Scholar 

  37. Windsor HM, Shanahan MX, Cherian K, Chang VP (1976) Tracheal injury following prolonged intubation. Aust N Z J Surg 46(1):18–25

    CAS  PubMed  Google Scholar 

  38. Seidl RO, Todt I, Westhofen M, Ernst A (2008) Tracheal rupture in burns—a retrospective study. Burns 34(4):525–530

    PubMed  Google Scholar 

  39. Chappell VL, Heck HA Jr (2007) Repair of large, iatrogenic, tracheo-esophageal fistulae. Ann Thorac Surg 83(2):705–706

    PubMed  Google Scholar 

  40. Suciu BA, Halmaciu I, Bud V et al (2018) The use of heterologous bovine pericardium in the surgical treatment of large tracheo-oesophageal fistulas and dilacerations of the membranous wall of the trachea. Case report. Ann Ital Chir 89:461–464

    PubMed  Google Scholar 

  41. Gerhardt HJ (1981) Transtracheal microsurgical closure of tracheoesophageal fistulas. Head Neck 4(1):64–68

    CAS  Google Scholar 

  42. Caronia FP, Reginelli A, Santini M et al (2017) Trans-tracheostomy repair of tracheo-esophageal fistula under endoscopic view in a 75-year old woman. J Thorac Dis 9(3):E176–E179

    PubMed  PubMed Central  Google Scholar 

  43. Zampieri D, Pangoni A, Marulli G, Rea F (2018) Acquired tracheoesophageal fistula repair, due to prolonged mechanical ventilation, in patient with double incomplete aortic arch. Monaldi Arch Chest Dis 88(3):974

    PubMed  Google Scholar 

  44. Cordos I, Bolca C, Paleru C, Posea R, Stoica R (2009) Sixty tracheal resections- single center experience. Interact Cardiovasc Thorac Surg 8(1):62–65

    PubMed  Google Scholar 

  45. Marulli G, Loizzi M, Cardillo G et al (2013) Early and late outcome after surgical treatment of acquired non-malignant tracheo-esophageal fistulae. Eur J Cardiothorac Surg 43(6):e155–161

    PubMed  Google Scholar 

  46. Krajc T, Janik M, Benej R et al (2009) Urgent segmental resection as the primary strategy in management of benign tracheal stenosis. A single center experience in 164 consecutive cases. Interact Cardiovasc Thorac Surg 9(6):983–989

    PubMed  Google Scholar 

  47. Foroulis CN, Nana C, Kleontas A et al (2015) Repair of post-intubation tracheoesohageal fistulae through the left pre-sternocleidomastoid approach: a recent case series of 13 patients. J Thorac Dis 7(Suppl 1):S20–26

    PubMed  PubMed Central  Google Scholar 

  48. Sileika N, Jovaisas V, Jagelavicius Z, Janilionis R (2013) Management of acquired benign tracheoesophageal fistula in adults: a twelve year experience. Lithuanian Surg 12(4):196–203

    Google Scholar 

  49. Marzelle J, Dartevelle P, Khalife J, Rojas-Miranda A, Chapelier A, Levasseur P (1989) Surgical management of acquired post-intubation tracheo-oesophageal fistulas: 27 patients. Eur J Cardiothorac Surg 3(6):499–502

    CAS  PubMed  Google Scholar 

  50. Gerzic Z, Rakic S, Randjelovic T (1990) Acquired benign esophagorespiratory fistula: report of 16 consecutive cases. Ann Thorac Surg 50(5):724–727

    CAS  PubMed  Google Scholar 

  51. Primov-Fever A, Talmi YP, Yellin A, Wolf M (2006) Cricotracheal resection for airway reconstruction: the Sheba medical center experience. Isr Med Assoc J 8(8):543–547

    PubMed  Google Scholar 

  52. Tazi-Mezalek R, Musani AI, Laroumagne S et al (2016) Airway stenting in the management of iatrogenic tracheal injuries: 10-year experience. Respirology 21:1452–1458

    PubMed  Google Scholar 

  53. Mathisen DJ, Grillo HC, Wain JC, Hilgenberg AD (1991) Management of acquired non-malignant tracheoesophageal fistula. Ann Thorac Surg 52(4):759–765

    CAS  PubMed  Google Scholar 

  54. Gudovsky LM, Koroleva NS, Biryukov YB, Chernousov AF, Perelman MI (1993) Tracheoesophageal fistulas. Ann Thorac Surg 55:868–875

    CAS  PubMed  Google Scholar 

  55. Deshpande G, Samarasam S, Banerjee S, Gnanamuthu RB, Chandran S, Mathew G (2013) Benign esophagorespiratory fistula: a case series and a novel technique of definitive management. Dis Esophagus 26(2):141–147

    CAS  PubMed  Google Scholar 

  56. Shen KR, Allen MS, Cassivi SD et al (2010) Surgical management of acquired non-malignant tracheoesophageal and bronchoesophageal fistulae. Ann Thorac Surg 90(3):914–918

    PubMed  Google Scholar 

Download references

Funding

All authors declare that there is no conflict of interest and there is no financial, personal or other relationship that might influence this work. There is no internal or external source of funding obtained for this study.

Author information

Authors and Affiliations

  1. Departments of Otolaryngology-Head and Neck Surgery, Kovai Medical Center and Hospital, Avinashi Road, Coimbatore, 641 014, India

    Muthuswamy Dhiwakar & Shivprakash Mehta

  2. Galilee Medical Center, Bar-Ilan University, Safed, Israel

    Ohad Ronen

  3. Milton Keynes University Hospital, Milton Keynes, UK

    Mrinal Supriya

Authors
  1. Muthuswamy Dhiwakar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ohad Ronen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mrinal Supriya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Shivprakash Mehta
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muthuswamy Dhiwakar.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dhiwakar, M., Ronen, O., Supriya, M. et al. Surgical repair of mechanical ventilation induced tracheoesophageal fistula. Eur Arch Otorhinolaryngol 277, 323–331 (2020). https://doi.org/10.1007/s00405-019-05723-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00405-019-05723-y

Keywords

Search

Navigation