EN
TÜRKÇE
Poster - 48
Isolated tracheo-esophageal or broncho/esophageal fistula: should we prefer an individualized multidisciplinary or a standardized approach?
M Torre*, G Mandrile*, G Brenco*, S Buratti**, R D'Agostino**, G Mattioli*
*University of Genova
**IRCCS Istituto Giannina Gaslini, Genova, Italy
Purpose: Isolated tracheo-esophageal fistula (TEF) and broncho-esophageal fistula (BEF), whether congenital (H-type), recurrent (post esophageal atresia repair), or acquired (post traumatic) represent infrequent and challenging conditions. The management strategies range from endoscopic to open surgical techniques, with an individualised multidisciplinary or a standardized approach. This study aims to retrospectively evaluate our approach and outcome.
Method: We reviewed all isolated TEF treated at our Institution over the past 10 years, analysing fistula location, clinical data, surgical approach, and outcome.
Results: 19 cases were treated (aged 11 days to 15.4 years), 15 of them referred after complications of other Centers. We adopted a multidisciplinary approach. 8 patients had a recurrent TEF that was treated endoscopically with trichloroacetic (TCA) chemocauterization, with a success rate of 75% (6 cases) after an average of 3.5 treatments. In 2 patients with failed endoscopic treatment (after 5 and 7 essays), open surgery was performed (one via thoracotomy, the other via sternotomy). Congenital H-type TEF (5 cases) underwent successful surgical ligation and division of the fistula in 4 cases (3 via cervical approach, 1 thoracoscopically), while a TCA chemocauterization was unsuccessful. Three post-traumatic large TEF (2 battery ingestion and 1 complicated tracheostomy) were treated with tracheal resection, through anterior cervicotomy or sternotomy. Three patients had a BEF due to sequelae of complicated EA repair: they underwent esophagostomy; esophagectomy (followed by laparo-assisted gastric pull up); fistula closure through right thoracotomy. None of the patients experienced recurrence of the TEF.
Conclusion: Our findings support an individualized treatment approach, a “one-fit-all” approach for isolated TEF or BEF was not an option. A multidisciplinary approach helped to achieve good results, with endoscopic treatment being effective for recurrent TEF in most cases, and open surgery reserved for post-traumatic and congenital H type TEF, as well as in cases of failure of endoscopic treatment.