Post intubation tracheo esophageal fistulae - critical analysis of its presentation and surgical management

Abstract

Aim: To evaluate the Presentation , Surgical management and outcome in Patients referred with Post intubation tracheoesophageal fistula to a tertiary care hospital. Methods: We report our experience with Six patients (male : female - 1:5 ) who presented with Post intubation tracheoesophageal fistula managed in a single center over a period of january 2012 –october 2014.The mean duration of intubation days was 21.8 days . At presentation patients were debilitated from either pulmonary complications of aspiration (n=3, 50%) and malnutrition (n=3, 50%). Patients were evaluated with Upper GI endoscopy , bronchoscopy, MRI neck and CECT neck. Preoperative nutritional support was managed with PEG, Nasogastric tube and feeding jejunostomy. The TEF was closed with primary repair of the oesophageal defect in single layer in all cases . Primary tracheal defect repair in three cases ,segmental resection of the trachea in three with single stage reconstruction in two patients, revision tracheostomy and delayed reconstruction of the trachea in one case. Sternocleido mastoid muscle flap interpostion in 5 cases. Results: Preoperative nutrition optimisation were given for all patients for a mean of 13.6 weeks. Postoperative complications developed in 33.3 % of patients (n=2). Mortality in two cases due to aspiration pneumonitis (n=2, 33.3%). Mean post operative hospital stay was 20 days (range, 8 – 56 days). Fistula closure was thus ultimately successful in 5 out of 6 patients (83.3%) and no long term complications during our mean follow-up of 2 years. Conclusions: Proper evaluation of Tracheoesophageal fistula is needed to assess the location, size and the adjacent tracheal lumen before planning definitive procedure.When there is no luminal compromise of the tracheal lumen, primary repair of the tracheal and oesophageal defects can be done. Interposition Muscle flap prevents re-fistulisation .Management is complex and the outcome depends on multiple factors.