Outcome and safety of tailored surgical treatments of nonmalignant esophagotracheobronchial fistula: report of fourteen patients

Figures & data

Figure 1 A 51-year-old female with esophagotracheal fistula for 7 months underwent division of the fistulous tract and closure of the trachea and esophagus.

Notes: (A) The tissue flap (arrow) is toward the trachea and before repair the entire opening of the fistula is opened toward the esophagus (tissue on the side of the trachea is scant). (B) The opening (between the vascular clamps) of the fistula is occluded with the tissue flap. Because the tissue flap is pulled toward the trachea, the gastric tube in the esophagus is seen. (C) The opening of the fistula after occlusion with the tissue flap.

Table 1 Demographic and baseline information of patients (N=14)

No	Gender	Age (years)	Diagnosis	Disease course (months)	Surgical approach	Type of surgery
1	Female	72	Esophagotracheal fistula	3	Right	Division of the fistulous tract and closure of the trachea and esophagus
2	Male	32	Fistula between the diverticulum of the esophagus and left bronchus	9	Left	Left lower lobectomy and lower esophagectomy, and infra-aortic arch anastomosis of the esophagus with the stomach
3	Male	61	Fistula between the esophagus and the left main stem bronchus	1	Left	Division of the fistulous tract and closure of the esophagus and left main stem bronchus
4	Male	40	Esophagotracheal fistula	6	Right	Division of the fistulous tract and closure of the trachea and esophagus
5	Female	58	Esophagotracheal fistula	7	Right	Division of the fistulous tract and closure of the trachea and esophagus
6	Male	47	Fistula between the thoracic stomach and the left main stem bronchus postsurgery for esophageal cancer	3	Right	Division of the fistulous tract and closure of the thoracic stomach and the left main stem bronchus
7	Male	56	Fistula between the thoracic stomach and the right main stem bronchus postsurgery for esophageal cancer with left thoracic incision and left cervical incision	2	Right	Division of the fistulous tract and closure of the thoracic stomach and the right main stem bronchus
8	Female	45	Esophagotracheal fistula	3	Right	Division of the fistulous tract and closure of the trachea and esophagus
9	Male	43	Esophagotracheal fistula	4	Right	Division of the fistulous tract and closure of the trachea and esophagus
10	Female	51	Esophagotracheal fistula postoperative right lower lobectomy	24	Right	Division of the fistulous tract and closure of the bronchus and esophagus
11	Female	44	Esophagotracheal fistula	15	Right	Division of the fistulous tract and closure of the trachea and esophagus
12	Female	48	Fistula between the diverticulum of the esophagus and the bronchus	30	Left	Left lower lobectomy and division of the fistulous tract and closure of the diverticulum of the esophagus
13	Male	49	Esophagotracheal fistula	550	Right	Division of the fistulous tract and closure of the trachea and esophagus
14	Male	59	Fistula between the esophagus and the mid segment of the right bronchus	600	Right	Right lower lobectomy and division of the fistulous tract and closure of the diverticulum of the esophagus

Figure 2 Preoperative diagnostic investigation.

Notes: (A) Esophagography demonstrates the outflow of radiopaque diagnostic medium from the esophagus into the trachea in a 51-year-old female with esophagotracheal fistula. (B) CT scan shows the opening of the esophagotracheal fistula. (C) Gastroendoscopy reveals the opening of the fistula in the esophagus in the same patient.
Abbreviation: CT, computed tomography.

Figure 3 The location of the esophagotracheal fistula is determined during the operation.

Table 2 Surgical treatments and outcomes of patients with acquired benign esophagorespiratory fistulae in the literature

Reference	Sample size	Intervention	Outcomes
Deshpande et al^Citation4	12	Primary closure of the esophageal defect and reinforcement with pleural or intercostal muscle flap or a subtotal esophagectomy; primary closure of the respiratory end of the fistula or neo-membranous airway formation (n=8)	Not reported
Shen et al^Citation11	35	Staged repair (n=6), division and primary repair (n=18), esophageal resection with reconstruction (n=4), esophageal diversion (n=6), suture closure of the esophageal or tracheal defect only (n=4), segmental tracheal or bronchial resection (n=3)	Operative mortality (n=2), complications (n=19), recurrence (n=3)
Muniappan et al^Citation12	36	Closure of the tracheal defect with resection and reconstruction (n=17), laryngotracheal resection (n=5), membranous tracheal repair (n=17), or repair over a tracheal T tube (n=2) and esophageal repair with 2-layer closure (n=31), 1-layer closure (n=6), esophagostomy (n=1), end- to-end esophageal anastomosis (n=1), or full-thickness skin graft reconstruction (n=1)	Postoperative death (n=1), recurrence (n=4)
Reed and Mathisen^Citation1	38	Simple division and closure of the fistula (n=9), tracheal resection and reconstruction (n=29), closure of the esophageal defect in 2 layers and a viable strap muscle interposed between the 2 suture lines	Death (n=4), recurrence (n=3), delayed tracheal stenosis (n=1)
Hilgenberg and Grillo^Citation6	20	Direct closure of the esophageal defect (n=16), end-to-end reconstruction of the esophagus (n=4)	Death (n=2), recurrence (n=1)
Gerzić et al^Citation5	16	Diverticulectomy, division of the fistula, and suture of both esophageal and respiratory defects (n=12); temporary gastrostomy (n=4)	Operative mortality (n=1), death (n=2, temporary gastrostomy)
Cherveniakov et al^Citation3	35	Simple excision of the fistula, longitudinal suture of the trachea and horizontal suture of the esophagus (n=9); circular resection with reconstruction of the trachea and plastic suture of the esophagus (n=6); esophagectomy with ensuing colon substitution (n=4); use of left sternocleidomastoid flap (n=12); palliative therapy (n=4)	Postoperative death (n=2), recurrence (n=4)
Baisi et al^Citation2	31	Dissection of the fistula and closure of the tracheal and esophageal defect (n=26), esophagogastroplasty plus closure of the tracheal defect and omental interposition (n=2), tracheal resection and reconstruction of the sternocleidomastoid muscle interposition (n=1), nonsurgical treatment (n=2)	Postoperative death (n=1), treatment failure (n=2)
This study	14	Division of the fistulous tract and closure of the esophagus and trachea (n=7) or bronchus (n=2); division of the fistulous tract and closure of the thoracic stomach and main stem bronchus (n=2); lower lobectomy and division of the fistulous tract and closure of the diverticulum of the esophagus (n=2); left lower lobectomy and lower esophagectomy, and infra-aortic arch anastomosis of the esophagus with the stomach (n=1)	No mortality, no complications, and no recurrence

DeshpandeGSamarasamIBanerjeeSGnanamuthuRBChandranSMathewGBenign esophagorespiratory fistula: a case series and a novel technique of definitive managementDis Esophagus201326214114722486830

 PubMed Web of Science ®Google Scholar

ShenKRAllenMSCassiviSDSurgical management of acquired nonmalignant tracheoesophageal and bronchoesophageal fistulaeAnn Thorac Surg2010903914918 discussion 91920732517

 PubMed Web of Science ®Google Scholar

MuniappanAWainJCWrightCDSurgical treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experienceAnn Thorac Surg20139541141114623000263

 PubMed Web of Science ®Google Scholar

ReedMFMathisenDJTracheoesophageal fistulaChest Surg Clin N Am200313227128912755313

 PubMedGoogle Scholar

HilgenbergADGrilloHCAcquired nonmalignant tracheoesophageal fistulaJ Thorac Cardiovasc Surg19838544924986834870

 PubMed Web of Science ®Google Scholar

GerzićZRakićSRandjelovićTAcquired benign esophagorespiratory fistula: report of 16 consecutive casesAnn Thorac Surg19905057247272241331

 PubMed Web of Science ®Google Scholar

CherveniakovATzekovCGrigorovGECherveniakovPAcquired benign esophago-airway fistulasEur J Cardiothorac Surg19961097137168905271

 PubMed Web of Science ®Google Scholar

BaisiABonavinaLNarneSPeracchiaABenign tracheoesophageal fistula: results of surgical therapyDis Esophagus199912320921110631915

 PubMed Web of Science ®Google Scholar