A Modified Tracheal Transaction Approach for the Repair of Nonmalignant Tracheoesophageal Fistulas: A Report of 5 Cases.

ABSTRACT

BACKGROUND: A postintubation tracheoesophageal fistula is a rare complication of a tracheotomy. Surgical repair is the only viable option for these patients, but the repair techniques presented in the literature vary. METHODS: We used a modified tracheal transaction approach to repair 5 cases of nonmalignant tracheoesophageal fistulas. The procedure was performed with a low cervical collar incision, and the trachea was transected directly. All the procedures were only carried out in the surgical field created by tracheostomy and paratracheal and esophageal dissection was no longer necessary. The esophageal and tracheal walls were separated. Then, a 2-layer longitudinal suture was used for esophageal reconstruction, and end-to-end anastomosis with excessive cartilage resection was used for tracheal reconstruction. RESULTS: A successful 1-stage repair of both the esophagus and the trachea was achieved in 4 cases. The remaining case had a tracheostomy fistula and required a second-stage reconstruction for a long (5.5 cm) defect of the tracheal membrane. No perioperative complications occurred, and all gastric tubes and tracheostomies were removed within 3 months of surgery. CONCLUSION: Based on our primary experience, this modified tracheal transection approach can be considered an appropriate choice for the reconstruction of nonmalignant tracheal fistulas.