title: Surgery and perioperative management for post-intubation tracheoesophageal fistula: case series analysis.
abstract: BACKGROUND
  Post-intubation tracheoesophageal fistula (PITEF) is an often mistreated, severe condition. This case series reviewed for both the choice and timing of surgical technique and outcome PITEF patients.
  
  
  METHODS
  This case series reviewed ten consecutive patients who had undergone esophageal defect repair and airway resection/reconstruction between 2000 and 2014. All cases were examined for patients: general condition, medical history, preparation to surgery, diagnostic work-up, timing of surgery and procedure, fistula size and site, ventilation type, nutrition, post-operative course and complications.
  
  
  RESULTS
  All patients were treated according to Grillo's technique. Overall, 6/10 patients had undergone a preliminary period of medical preparation. Additionally, 3 patients had already had a tracheostomy, one had had a gastrostomy and 4 had both. One patient had a Dumon stent with enlargement of the fistula. Concomitant tracheal stenosis had been found in 7 patients. The mean length of the fistulas was 20.5 mm (median 17.5 mm; range, 8-45 mm), at a median distance from the glottis of 43 mm (range, 20-68 mm). Tracheal resection was performed in all ten cases. The fistula was included in the resection in 6 patients, while it was excluded in the remaining 4 due to their distance. Post-repair tracheotomy was performed in 3 patients. The procedure was performed in 2 ventilated patients. Morbidity related to fistula and anastomosis was recorded in 3 patients (30%), with one postoperative death (10%); T-Tube placement was necessary in 3 patients, with 2/3 decannulations after long-stenting. Definitive PITEF closure was obtained for all patients. At 5-year follow-up, the 9 surviving patients had no fistula-related morbidity.
  
  
  CONCLUSIONS
  Primary esophageal closure with tracheal resection/reconstruction seemed to be effective treatment both short and long-term. Systemic conditions, mechanical ventilation, detailed preoperative assessment and appropriate preparation were associated with outcome. Indeed, the 3 patients who had received T-Tube recovered from anastomotic complications.
authors.affiliation: Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Puma
authors.affiliation: Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
authors.forename: Jacopo
authors.initials: J
authors.lastname: Vannucci
authors.affiliation: Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Santoprete
authors.affiliation: Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
authors.forename: Moira
authors.initials: M
authors.lastname: Urbani
authors.affiliation: Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Cagini
authors.affiliation: Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Andolfi
authors.affiliation: Department of Thoracic Surgery, University of Perugia Medical School, Perugia, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Potenza
authors.affiliation: Thoracic Surgery Unit, Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
authors.forename: Niccolò
authors.initials: N
authors.lastname: Daddi
keywords: Tracheoesophageal fistula; airway; esophagus; intensive care; surgery