Surgical Treatment for Non-malignant Esophageal-tracheal/bronchial Fistula_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GUO Feng , ZHANG Zhiyong , CUI Yushang , LI Li , LI Shanqing , XU Xiaohui.

Department of Thoracic Surgery，Peking Union Medical College Hospital，Chinese Academy of Medical Sciences &;
Peking Union Medical College，Beijing 100730，P. R. China;

Corresponding author：

Keywords：

Non-malignant; ?Esophageal-tracheal/bronchial fistula; ?Surgery

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ObjectiveTo investigate clinical characteristics and surgical treatment of patients with non-malignant esophageal-tracheal/bronchial fistula.?Methods?We retrospectively analyzed clinical data of 12 patients with non-malignant esophageal-tracheal/bronchial fistula who underwent surgical repair in Peking Union Medical College Hospital from January 2002 to October 2011. There were 6 males and 6 females with a mean age of 49.8 years (ranging from 32 to 72 years). There were 7 patients with esophagotracheal fistula，1 patient with esophagobronchial fistula，2 patients with gastro-bronchial fistula after esophagectomy for esophageal cancer，and 2 patients with esophageal diverticulum bronchial fistula. Nine patients underwent surgical repair via right thoracotomy approach，and 3 patients via left thoracotomy approach. Seven patients underwent esophageal fistula and tracheal fistula repair，1 patient underwent esophageal fistula and bronchial fistula repair，2 patients underwent gastric fistula and bronchial fistula repair，1 patient underwent esophagectomy, gastroesophageal anastomosis and left lower lobectomy, and 1 patient underwent esophageal diverticulum repair and left lower lobectomy.?Results?All the patients recovered well from surgery with no perioperative complication or in-hospital death，and resumed oral intake 7-10 days after surgery. Three months to 1 year postoperatively, regular examinations including upper gastroenterography and　fibrobronchoscopy found no sign of tracheal/bronchial stenosis or esophageal stenosis，and no patients needed stent implantation or dilatation treatment. All the patients were followed up from 3 months to 10 years and had a good quality of life during follow-up.?Conclusion?Excluding malignant etiology and determining the exact fistula location are key points of clinical diagnosis for esophageal-tracheal/bronchial fistula. Adequate preoperative nutritional support and 1-stage surgical repair can lead to satisfactory clinical outcomes.

Citation： GUO Feng,ZHANG Zhiyong,CUI Yushang,LI Li,LI Shanqing,XU Xiaohui.. Surgical Treatment for Non-malignant Esophageal-tracheal/bronchial Fistula. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(5): 468-471. doi: Copy

1.	Reed MF， Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am， 2003， 13 （2）：271-289.
2.	Camargo JJ， Machuca TN， Camargo SM， et al. Surgical treatment of benign tracheo-oesophageal fistulas with tracheal resection and oesophageal primary closure： is the muscle flap really necessary?? Eur J Cardiothorac Surg，2010，37 （3）：576-580.
3.	Shen KR， Allen MS， Cassivi SD， et al. Surgical management of acquired nonmalignant tracheoesophageal and bronchoesophageal fistulae. Ann Thorac Surg ，2010， 90 （3）：914-919.
4.	Chappell VL， Heck Jr HA. Repair of large， iatrogenic， tracheo-esophageal fistulae. Ann Thorac Surg ，2007， 83 （2）：705-706.
5.	Bardini R， Radicchi V， Parimbelli P， et al. Repair of a recurrent benign tracheoesophageal fistula with a Gore-Tex membrane. Ann Thorac Surg， 2003， 76 （1）：304-306.
6.	Marzelle J， Dartevelle P， Khalife J， et al. Surgical management of acquired postintubation trachea-oesophageal fistulas： 27 patients. Eur J Cardiothorac Surg， 1989，3 （6）：499-503.
7.	Cherveniakov A， Tzekov C， Grigorov GE， et al. Acquired benign esophago-airway fistulas. Eur J Cardiothorac Surg， 1996， 10 （9）：713-716.
8.	Macchiarini P， Verhoye JP， Chapelier A， et al. Evaluation and outcome of different surgical techniques for postintubation tracheoesophageal fistulas. J Thorac Cardiovasc Surg， 2000， 119 （2）：268-276.
9.	Kovesi T， Rubin S. Long-term complications of congenital esophageal atresia and/or tracheoesophageal fistula. Chest， 2004， 126 （3）：915-925.
10.	雷杰，张娜，骆晴，等. 食管癌食管支气管瘘的外科治疗. 中国胸心血管外科临床杂志， 2012， 19 （1）：36-38.
11.	Han Y， Liu K， Li X， et al. Repair of massive stent-induced tracheoesophageal fistula. J Thorac Cardiovasc Surg， 2009， 137 （4）： 813-817.
12.	Talbot ML， Hugh TB， Spratt P. Gastric antral patch oesophagoplasty for iatrogenic tracheo-oesophageal fistula. ANZ J Surg ，2007，77 （4）：295-297.
13.	Golash V. Single-stage repair of a large acquired tracheoesophageal fistula with interposition of 2 muscle pedicle flaps and laparoscopic gastrojejunostomy. J Thorac Cardiovasc Surg， 2006， 131 （6）：1413-1414.
14.	Schembre DB. Recent advances in the use of stents for esophageal disease. Gastrointest Endosc Clin N Am， 2010，20 （1）：103-121.
15.	Rabenstein T， Boosfeld C， Henrich R， et al. First use of ventricular septal defect occlusion device for endoscopic closure of an esophagorespiratory fistula using bronchoscopy and esophagoscopy. Chest， 2006，130 （3）： 906-909.
16.	Garand SA， Kareti LR， Dumont TM， et al. Thoracoscopic repair of tracheoesophageal fistula in a　septuagenarian. Ann Thorac Surg， 2006， 81 （5）：1899-1901.
17.	Altorjay Á， Mucs M， Rüll M， et al. Recurrent， nonmalignant tracheoesophageal fistulas and the need for surgical improvisation. Ann Thorac Surg， 2010， 89 （6）：1789-1796.

1. 　Reed MF， Mathisen DJ. Tracheoesophageal fistula. Chest Surg Clin N Am， 2003， 13 （2）：271-289.
2. 　Camargo JJ， Machuca TN， Camargo SM， et al. Surgical treatment of benign tracheo-oesophageal fistulas with tracheal resection and oesophageal primary closure： is the muscle flap really necessary?? Eur J Cardiothorac Surg，2010，37 （3）：576-580.
3. 　Shen KR， Allen MS， Cassivi SD， et al. Surgical management of acquired nonmalignant tracheoesophageal and bronchoesophageal fistulae. Ann Thorac Surg ，2010， 90 （3）：914-919.
4. 　Chappell VL， Heck Jr HA. Repair of large， iatrogenic， tracheo-esophageal fistulae. Ann Thorac Surg ，2007， 83 （2）：705-706.
5. 　Bardini R， Radicchi V， Parimbelli P， et al. Repair of a recurrent benign tracheoesophageal fistula with a Gore-Tex membrane. Ann Thorac Surg， 2003， 76 （1）：304-306.
6. 　Marzelle J， Dartevelle P， Khalife J， et al. Surgical management of acquired postintubation trachea-oesophageal fistulas： 27 patients. Eur J Cardiothorac Surg， 1989，3 （6）：499-503.
7. 　Cherveniakov A， Tzekov C， Grigorov GE， et al. Acquired benign esophago-airway fistulas. Eur J Cardiothorac Surg， 1996， 10 （9）：713-716.
8. 　Macchiarini P， Verhoye JP， Chapelier A， et al. Evaluation and outcome of different surgical techniques for postintubation tracheoesophageal fistulas. J Thorac Cardiovasc Surg， 2000， 119 （2）：268-276.
9. 　Kovesi T， Rubin S. Long-term complications of congenital esophageal atresia and/or tracheoesophageal fistula. Chest， 2004， 126 （3）：915-925.
10. 　雷杰，张娜，骆晴，等. 食管癌食管支气管瘘的外科治疗. 中国胸心血管外科临床杂志， 2012， 19 （1）：36-38.
11. 　Han Y， Liu K， Li X， et al. Repair of massive stent-induced tracheoesophageal fistula. J Thorac Cardiovasc Surg， 2009， 137 （4）： 813-817.
12. 　Talbot ML， Hugh TB， Spratt P. Gastric antral patch oesophagoplasty for iatrogenic tracheo-oesophageal fistula. ANZ J Surg ，2007，77 （4）：295-297.
13. 　Golash V. Single-stage repair of a large acquired tracheoesophageal fistula with interposition of 2 muscle pedicle flaps and laparoscopic gastrojejunostomy. J Thorac Cardiovasc Surg， 2006， 131 （6）：1413-1414.
14. 　Schembre DB. Recent advances in the use of stents for esophageal disease. Gastrointest Endosc Clin N Am， 2010，20 （1）：103-121.
15. 　Rabenstein T， Boosfeld C， Henrich R， et al. First use of ventricular septal defect occlusion device for endoscopic closure of an esophagorespiratory fistula using bronchoscopy and esophagoscopy. Chest， 2006，130 （3）： 906-909.
16. 　Garand SA， Kareti LR， Dumont TM， et al. Thoracoscopic repair of tracheoesophageal fistula in a　septuagenarian. Ann Thorac Surg， 2006， 81 （5）：1899-1901.
17. 　Altorjay Á， Mucs M， Rüll M， et al. Recurrent， nonmalignant tracheoesophageal fistulas and the need for surgical improvisation. Ann Thorac Surg， 2010， 89 （6）：1789-1796.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical Treatment for Non-malignant Esophageal-tracheal/bronchial Fistula

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