Preoperative catheterization of H-type tracheoesophageal fistula to facilitate its localization and surgical correction.

PURPOSE: The aim of this study was to demonstrate that preoperative catheterization of H-type tracheoesophageal fistula facilitates its identification and surgical correction. METHODS: This is a case series of seven patients with H-type tracheoesophageal fistula. Diagnosis was established in three patients and suspected in two more by means of an esophagogram. Confirmation of fistula was performed by endoscopy in all patients. On the day of surgery, either a rigid bronchoscope or a nasolaryngoscope was introduced into the trachea to localize and catheterize the fistula. Because of the location of the fistula, the surgical correction was performed through the neck in five patients and through the thorax in two patients. The fistulas were easily identified surgically and the corrections were successfully performed in all cases. An extensive dissection was not required in any case. Refistulization, identified by bronchoscopic examination one week after surgery, occurred in one patient. Surgical repair was performed again using same procedure described above. All patients are currently asymptomatic and without any evidence of refistulization. CONCLUSIONS: Preoperative catheterization of H-type tracheoesophageal fistula is useful to facilitate its preoperative identification, to plan the surgical approach, and to decrease operating times and the extent of surgery.

A new endoscopic procedure for membranectomy of fenestrated duodenal membranes.

AIM OF THE STUDY: We describe a new endoscopic procedure for membranectomy of fenestrated duodenal membranes. METHODS: With the patients under general anesthesia and tracheally intubated, a flexible video-panendoscope was introduced into the second portion of the duodenum. The fenestrated membrane was visualized and a triple-lumen stone extraction balloon of 15 mm was inserted through the fenestration. After the balloon was insufflated, gentle traction was performed in order to expose the fenestrated membrane and differentiate it from the normal duodenal wall. The orifice was dilated in order to introduce the endoscope and localize the Vater's ampulla. A sphincterotome was used to carry out one or two incisions of 1.5 to 2 cm in the membrane in the opposite direction to the ampulla. RESULTS: The procedure was successfully performed in five patients with a mean surgical time of 50 minutes. None of the patients complained of postoperative pain. Peristalsis was not affected, and patients started intake of oral fluids at approximately 24 hours. On discharge patients were completely asymptomatic, and four patients were followed up for one year following the procedure and remained asymptomatic. One patient who was also asymptomatic did not continue follow-up longer than two weeks after the procedure. CONCLUSION: Endoscopic membranectomy of duodenal membranes is a safe and effective procedure that reduces surgical times, postoperative fasting times and the length of hospitalization, and probably has no postoperative complications.