Repair of challenging non-malignant tracheo- or broncho-oesophageal fistulas by extrathoracic muscle flaps.

Details

Serval ID
serval:BIB_8F7F90C1C5D1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Repair of challenging non-malignant tracheo- or broncho-oesophageal fistulas by extrathoracic muscle flaps.
Journal
European journal of cardio-thoracic surgery
Author(s)
Rosskopfova P., Perentes J.Y., Schäfer M., Krueger T., Lovis A., Dorta G., Baeriswyl M., Ris H.B., Gonzalez M.
ISSN
1873-734X (Electronic)
ISSN-L
1010-7940
Publication state
Published
Issued date
01/05/2017
Peer-reviewed
Oui
Volume
51
Number
5
Pages
844-851
Language
english
Notes
Publication types: Journal Article
Publication Status: ppublish
Abstract
Evaluation of complex, acquired, non-malignant tracheo/broncho-oesophageal fistulas (TEF) repaired by extrathoracic pedicled muscle flaps that were, in addition to their interposition between the airways and the gastro-intestinal tract, patched into gastro-intestinal or airway defects if primary closure seemed risky.
A single institution experience of patients treated between 2003 and 2015. Twenty-two patients required TEF repair following oesophageal surgery (18), Boerhaave syndrome (1), chemotherapy for mediastinal lymphoma (1), carinal resection and irradiation (1) and laryngectomy (1); 64% of them underwent prior radio- or chemotherapy and 50% prior airway or oesophageal stenting.
Airway defects were closed by muscle flap patch ( n  = 12), lobectomy ( n  = 4), airway resection/anastomosis ( n  = 2), pneumonectomy ( n  = 1), segmentectomy ( n  = 2) or primary suture ( n  = 1). Gastro-intestinal defects were repaired by oesophageal diversion ( n  = 9), muscle flap patch ( n  = 8) or primary suture ( n  = 5). A muscle flap patch was used to close airway and gastro-intestinal defects in 55% and 36% of cases, respectively. The 90-day postoperative mortality and TEF recurrence rates were 18% and 4.5%. Airway healing and breathing without tracheal appliance was obtained in 95% of patients and gastro-intestinal healing in 77% of those without oesophageal diversion. Five of nine patients with oesophageal diversion underwent intestinal restoration by retrosternal colon transplants.
Complex TEF arising after oesophageal surgery, radio-chemotherapy or failed stenting can be successfully closed using extrathoracic muscle flaps that can, in addition to their interposition between the airway and the gastro-intestinal tract, also be patched into gastro-oesophageal or airway defects if primary closure seems hazardous.

Keywords
Adolescent, Adult, Aged, Bronchial Fistula/epidemiology, Bronchial Fistula/surgery, Child, Female, Humans, Male, Middle Aged, Postoperative Complications, Reoperation, Retrospective Studies, Surgical Flaps/surgery, Thoracic Surgical Procedures/adverse effects, Thoracic Surgical Procedures/methods, Thoracic Surgical Procedures/mortality, Trachea/surgery, Tracheoesophageal Fistula/epidemiology, Tracheoesophageal Fistula/surgery, Young Adult, Airway, Neoadjuvant induction therapy, Oesophageal surgery, Tracheal surgery, Tracheo-oesophageal fistula
Pubmed
Web of science
Open Access
Yes
Create date
07/02/2017 19:41
Last modification date
20/08/2019 15:53
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