[The one-time surgical repair of postintubation esophagotracheal fistulae].
Personal experience in the treatment of the tracheal-esophageal non-neoplastic fistula is reported. In the last years, three cases of FTE, concerning some cannula tracheal-stomachal beare patients from 14, 2, 1 months have been examined. In two cases the patients were in spontaneous ventilation, on the contrary a mechanical ventilation was employed in the third. In two patients the fistular way was located correspondingly of the decubitus point of the tracheal stomachal cannula, on the membranaceous pars, and it was not associated with concomitant tracheal stenosis. The first stage of the treatment was removal of the nasogastric probe, supporting the decubitus phenomenon subtending the establishment and the extension of the FTE, then the preparation of a gastrostomy to assure the drainage of secretions under the fistula and a jejunum anastomosis to allow a suitable feeding and recovery of the patients. In these three cases the restoring operation was accomplished by a cervicotomy with a direct opening of the fistula, a suture of the esophageal wall, a suture of the membranaceous pars on the healthy tissue and then a protection of these sutures by interposition, between trachea and esophagus, of the prethyroid muscles transposed and fixed to the prevertebral band. In two cases the post-operative course did not present complications, while the patients kept in assisted ventilation during the postoperative course showed a relapse of the FTE on the twelfth day and then the progressive establishment of a septic state and the exitus on the twentieth day. It is underlined how the success of the reparation of the fistula is largely conditioned by the respiratory autonomy of the patient that guarantees the recurrence of decubitus and infection phenomena causing the lesion.
Loizzi
M
M
Cattedra di Chirurgia Toracica, Università degli Studi, Bari.
Sardelli
P
P
Sollitto
F
F
Lopez
C
C
Lacitignola
A
A
Pizzigallo
M A
MA
D000328:Adult; D002908:Chronic Disease; D020878:Device Removal; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000009:adverse effects* / Q000295:instrumentation; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures; D012008:Recurrence; D014132:Trachea / Q000601:surgery; D014135:Tracheal Stenosis / Q000209:etiology / Q000601:surgery; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery*