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European Respiratory Review : An... Dec 2020Tracheo-oesophageal fistula (TOF) is a pathological connection between the trachea and the oesophagus that is associated with various underlying conditions including... (Review)
Review
Tracheo-oesophageal fistula (TOF) is a pathological connection between the trachea and the oesophagus that is associated with various underlying conditions including malignancies, infections, inhalation injuries and traumatic damage. As the condition spans multiple organ systems with varying aetiologies and acuities, TOF poses unique diagnostic and management challenges to pulmonologists, gastroenterologists and thoracic surgeons alike. Although stents have been a cornerstone in the management of TOF, there exists a large gap in our understanding of their efficacy and precise methodology, making stenting procedure both art and science. TOFs relating to underlying oesophageal or tracheal malignancies require advanced understanding of the airway and digestive tract anatomy, dimensions of the fistula, stent characteristics and types, and the interplay between the oesophageal stent and the airway stent if dual stenting procedure is elected. In this review article, we review the most up-to-date data on risk factors, clinical manifestations, diagnostic approaches, management methods and prognosis. Consequently, this article serves to evaluate current therapeutic strategies and the future directions in the areas of 3D-printed stents, over-the-scope clipping systems, tissue matrices and atrial septal closure devices.
Topics: Adult; Humans; Prognosis; Stents; Trachea; Tracheoesophageal Fistula
PubMed: 33153989
DOI: 10.1183/16000617.0094-2020 -
The New England Journal of Medicine Mar 2021
Topics: Abnormalities, Multiple; Bronchial Fistula; Constriction, Pathologic; Esophageal Fistula; Fatal Outcome; Humans; Infant, Newborn; Male; Radiography; Trachea
PubMed: 33657297
DOI: 10.1056/NEJMicm2027782 -
Transplantation Aug 2023Long-segment tracheal airway defects may be congenital or result from burns, trauma, iatrogenic intubation damage, or tumor invasion. Although airway defects <6 cm in... (Review)
Review
Long-segment tracheal airway defects may be congenital or result from burns, trauma, iatrogenic intubation damage, or tumor invasion. Although airway defects <6 cm in length may be reconstructed using existing end-to-end reconstructive techniques, defects >6 cm continue to challenge surgeons worldwide. The reconstruction of long-segment tracheal defects has long been a reconstructive dilemma, and these defects are associated with significant morbidity and mortality. Many of these defects are not compatible with life or require a permanent extended-length tracheostomy that is fraught with complications including mucus plugging and tracheoesophageal fistula. Extensive circumferential tracheal defects require a reconstructive technique that provides a rigid structure able to withstand the inspiratory pressures, a structure that will biologically integrate, and contain functional ciliated epithelium to allow for normal mucociliary clearance. Tracheal transplantation has been considered the reconstructive "Holy Grail;" however, there has been a long-held scientific dogma that revascularization of the trachea was not possible. This dogma stifled research to achieve single-staged vascularized tracheal transplantation and prompted the introduction of many creative and inventive alternatives. Throughout history, alloplastic material, nonvascularized allografts, and homografts have been used to address this dilemma. However, these techniques have largely been unsuccessful. The recent introduction of a technique for single-staged vascularized tracheal transplantation may offer a solution to this dilemma and potentially a solution to management of the fatal tracheoesophageal fistula.
Topics: Humans; Trachea; Tracheoesophageal Fistula; Transplantation, Homologous; Tracheal Diseases; Organ Transplantation; Graft Rejection
PubMed: 36782283
DOI: 10.1097/TP.0000000000004509 -
American Journal of Respiratory and... Mar 2023
Topics: Humans; Trachea; Stents; Fistula
PubMed: 36214817
DOI: 10.1164/rccm.202201-0066IM -
Journal of Bronchology & Interventional... Oct 2015Tracheostomy tube placement is a therapeutic procedure that has gained increased favor over the past decade. Upper airway obstructions, failure to liberate from the... (Review)
Review
Tracheostomy tube placement is a therapeutic procedure that has gained increased favor over the past decade. Upper airway obstructions, failure to liberate from the ventilator, and debilitating neurological conditions are only a few indications for tracheostomy tube placement. Tracheostomy tubes can be placed either surgically or percutaneously. A percutaneous approach offers fewer surgical site infections and postsurgical bleeding than a surgical approach. A surgical placement posses a lower risk of injury to the posterior tracheal wall and spontaneous decannulation is less common. Late complications of both approaches include stenosis, malacia, along with tracheoesophageal, tracheoinnominate, and tracheocutaneous fistulas. This review describes the indications and methods of placement of tracheostomy tubes along with early and late complications that may occur following placement.
Topics: Constriction, Pathologic; Fistula; Humans; Postoperative Complications; Trachea; Tracheomalacia; Tracheostomy
PubMed: 26348694
DOI: 10.1097/LBR.0000000000000177 -
Cirugia Espanola Dec 2021
Topics: Humans; Respiratory Tract Fistula; Thyroidectomy; Trachea
PubMed: 34764059
DOI: 10.1016/j.cireng.2021.10.010 -
Thoracic Surgery Clinics Aug 2018When a malignant fistula develops between esophagus and trachea, the underlying cancer is invariably incurable whether the primary site is in the esophagus or in the... (Review)
Review
When a malignant fistula develops between esophagus and trachea, the underlying cancer is invariably incurable whether the primary site is in the esophagus or in the trachea. The frequent complication of this fistula is nonresolving aspiration pneumonia, either from ingestion or from backward flow of gastric contents into the esophagus. Pulmonary sepsis causes fatality in about 6 to 12 weeks if aspiration through the fistula is not treated quickly. The fistula develops in untreated esophageal cancer in approximately 5% to 15% of cases, lung cancer in less than 1% of cases, and tracheal cancer in 14.75% of cases.
Topics: Chemoradiotherapy; Combined Modality Therapy; Esophageal Neoplasms; Esophagectomy; Esophagus; Humans; Palliative Care; Trachea; Tracheal Neoplasms; Tracheoesophageal Fistula
PubMed: 30054077
DOI: 10.1016/j.thorsurg.2018.04.007 -
Annali Italiani Di Chirurgia 2012Thyroidectomy is considered a low-risk operation. The authors report a case of tracheal necrosis after total thyroidectomy for multinodular goiter with bilateral... (Review)
Review
BACKGROUND
Thyroidectomy is considered a low-risk operation. The authors report a case of tracheal necrosis after total thyroidectomy for multinodular goiter with bilateral adenomas, and a case of oesophageal fistula after total thyroidectomy for papillary cancer.
METHODS AND RESULTS
The patient with tracheal perforation was treated by a non operative management after clinical stabilization. The patient with oesophageal perforation underwent surgical treatment consisting of neck drain placement. Both patients are alive after 12 months of follow-up, although the patient who had surgery for papillary cancer of the thyroid gland was found to have multiple diffuse liver and lung metastases.
CONCLUSIONS
Thyroidectomy is a safe surgical procedure, but in some patients major complications may arise. In cases of iatrogenic tracheal or oesophageal perforation, conservative non-surgical or conservative surgical treatment, in specialized centers, results in a favourable outcome. The authors discuss the risk factors and management of these two rare complications.
Topics: Aged; Esophageal Fistula; Humans; Male; Necrosis; Thyroidectomy; Trachea
PubMed: 22610123
DOI: No ID Found -
Pediatric Radiology Oct 2021Tracheal atresia causes some secondary changes (dilated trachea, flattened/inverted diaphragm, hyperintense and hyperinflated lungs). They can be reduced if a high...
BACKGROUND
Tracheal atresia causes some secondary changes (dilated trachea, flattened/inverted diaphragm, hyperintense and hyperinflated lungs). They can be reduced if a high airway fistula is present.
OBJECTIVE
This study evaluated fetal MR images of tracheal atresia and the secondary changes, focusing on the presence of a fistula.
MATERIALS AND METHODS
We assessed fetal MR images of tracheal atresia without fistula (n=4, median 26 weeks), tracheal atresia with fistula (n=4, median 33 weeks) and controls (n=30, median 32 weeks). We evaluated airway obstruction using true-positive rate in tracheal atresia and false-positive rate in controls indicating they are likely normal variants. Tracheal diameter, craniocaudal-anteroposterior ratio of the right hemidiaphragm, lung-to-liver signal intensity ratio, and cardiothoracic ratio were compared among the three groups using the Kruskal-Wallis test followed by pairwise comparison using the Mann-Whitney U test.
RESULTS
True-positive rate was 100% in tracheal atresia, while false-positive rate was 20% in controls. The Kruskal-Wallis test showed differences among groups in craniocaudal-anteroposterior ratio and cardiothoracic ratio (P<0.001) but not in tracheal diameter (P=0.256) or lung-to-liver signal intensity ratio (P=0.082). The pairwise comparison in craniocaudal-anteroposterior ratio and cardiothoracic ratio showed differences between controls and tracheal atresia without fistula (P<0.01) and with fistula (P<0.05).
CONCLUSION
Fetal MRI is useful for the diagnosis of tracheal atresia, and detection of airway obstruction is essential. Lower craniocaudal-anteroposterior ratio and cardiothoracic ratio might be reliable measures even if a fistula is present.
Topics: Airway Obstruction; Esophageal Atresia; Humans; Magnetic Resonance Imaging; Respiratory System Abnormalities; Trachea; Tracheoesophageal Fistula
PubMed: 33988754
DOI: 10.1007/s00247-021-05092-x -
Khirurgiia 2023To describe treatment of cicatricial tracheal stenosis and tracheoesophageal fistula in patients with COVID-19 pneumonia.
OBJECTIVE
To describe treatment of cicatricial tracheal stenosis and tracheoesophageal fistula in patients with COVID-19 pneumonia.
MATERIAL AND METHODS
There were 91 patients with cicatricial tracheal stenosis for the period from August 2020 to April 2022 (21 months). Of these, 32 (35.2%) patients had cicatricial tracheal stenosis, tracheoesophageal fistula and previous coronavirus infection with severe acute respiratory syndrome. Incidence of iatrogenic tracheal injury following ventilation for viral pneumonia in the pandemic increased by 5 times compared to pneumonia of other genesis. Majority of patients had pneumonia CT grade 4 (12 patients) and grade 3 (8 patients). Other ones had pulmonary parenchyma lesion grade 2-3 or mixed viral-bacterial pneumonia. Isolated tracheoesophageal fistula without severe cicatricial stenosis of trachea or esophagus was diagnosed in 4 patients. In other 2 patients, tracheal stenosis was combined with tracheoesophageal fistula. Eight (25%) patients had tracheostomy at the first admission. This rate was almost half that of patients treated for cicatricial tracheal stenosis in pre-pandemic period.
RESULTS
Respiratory distress syndrome occurred in 1-7 months after discharge from COVID hospital. All patients underwent surgery. In 7 patients, we preferred palliative treatment with dilation and stenting until complete rehabilitation. In 5 patients, stent was removed after 6-9 months and these ones underwent surgery. There were 3 tracheal resections with anastomosis, and 2 patients underwent tracheoplasty. Resection was performed in 3 patients due to impossible stenting. Postoperative course in these patients was standard and did not differ from that in patients without viral pneumonia. In case of tracheoesophageal fistula, palliative interventions rarely allowed isolation of trachea. Four patients underwent surgery through cervical approach. There were difficult surgeries in 2 patients with tracheoesophageal fistula and cicatricial tracheal stenosis. One of them underwent separation of fistula and tracheal resection via cervical approach at primary admission. In another patient with thoracic fistula, we initially attempted to insert occluder. However, open surgery was required later due to dislocation of device.
CONCLUSION
Absolute number of patients with tracheal stenosis, tracheoesophageal fistula and previous COVID-19 has increased by several times compared to pre-pandemic period. This is due to greater number of patients requiring ventilation with risk of tracheal injury, non-compliance with preventive protocol for tracheal injury including anti-ischemic measures during mechanical ventilation. The last fact was exacerbated by involvement of allied physicians with insufficient experience of safe ventilation in the «red zone», immunodeficiency in these patients aggravating purulent-inflammatory process in tracheal wall. The number of patients with tracheostomy was 2 times less that was associated with peculiarity of mechanical ventilation in SARS-CoV-2. Indeed, tracheostomy was a poor prognostic sign and physicians tried to avoid this procedure. Incidence of tracheoesophageal fistula in these patients increased by 2 times compared to pre-pandemic period. In subacute period of COVID-associated pneumonia, palliative measures for cicatricial tracheal stenosis and tracheoesophageal fistula should be preferred. Radical treatment should be performed after 3-6 months. Absolute indication for circular tracheal resection with anastomosis is impossible tracheal stenting and ensuring safe breathing by endoscopic methods, as well as combination of cicatricial tracheal stenosis with tracheoesophageal fistula and resistant aspiration syndrome. Incidence of postoperative complications in patients with cicatricial tracheal stenosis and previous mechanical ventilation for COVID-19 pneumonia and patients in pre-pandemic period is similar.
Topics: Humans; Trachea; Tracheal Stenosis; Constriction, Pathologic; Tracheoesophageal Fistula; COVID-19; SARS-CoV-2; Pneumonia, Viral
PubMed: 36583489
DOI: 10.17116/hirurgia202301113