JTCS KCI
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fayoumi, S.
Right arrow Articles by Sawalhi, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fayoumi, S.
Right arrow Articles by Sawalhi, S.
Related Collections
Right arrow Trachea and bronchi

J Thorac Cardiovasc Surg 2007;133:1103-1104
© 2007 The American Association for Thoracic Surgery

Brief Communication

Closure of tracheogastric fistula by video-assisted tracheoscopy, direct repair, and self-expandable titanium stent in a patient with total laryngopharyngoesophagectomy

Said Fayoumi, MD*, Samer Sawalhi, MD

King Hussein Cancer Center, Department of Surgery, Amman, Jordan.

Received for publication August 3, 2006; accepted for publication October 23, 2006.

* Address for reprints: Said Fayoumi, MD, Department of Surgery, King Hussein Cancer Center, Amman, Jordan. (Email: Fayoumi{at}gmail.com).

A fistula between the trachea and an oseophagogastric anastamosis after oseophagectomy is uncommon.1Go An alternative means of reconstruction after laryngopharyngo-oseophagectomy should be considered.2Go Kalm’ar and associates3Go used the pectoralis major muscle flap to prevent recurrence of the fistula. The advent of video-assisted technology provided an effective, definitive, and one-stage repair of tracheogastric fistula (TGF).

Clinical Summary

A 33-year-old man was known to have squamous cell carcinoma of the hypopharynx, to have hypertension, and to be a smoker. He reported dysphagia, weight loss, and hoarseness. An endoscopic examination of the upper gastrointestinal tract showed stenotic stricture at the cricopharyngeal junction. The biopsy result was moderately differentiated squamous cell carcinoma.

The patient underwent 28 fractions of radiotherapy and 25 sessions of chemotherapy (5-fluorouracil and cisplatin), then total laryngectomy, pharyngectomy, esophagectomy and gastric pull-up (transhiatal approach). He was discharged in good general condition.

Three months later, the patient was admitted via the casualty department with shortness of breath, choking, and coughing, especially with water, after meals. Because TGF was suspected, an examination with a rigid bronchoscope was performed, which disclosed TGF at the upper membranous part of trachea (Figure 1). A biopsy specimen was negative for tumor.


Figure 1
View larger version (55K):
[in this window]
[in a new window]

  		Figure 1. A, Tracheogastric fistula at the membranous part of trachea shows mucosal folds of stomach at the opposite site. B, Diagram shows site of the fistula, which connected to the cardia.

 
The TGF was closed directly through video-assisted thoracic surgery (VATS) by 2-0 Vicryl polyglactin 910 sutures reinforced by insertion of a self-expandable titanium stent (see video). Five days later, the patient was readmitted with recurrence of the fistula. The stent was removed and the fistula resutured by VATS, taking full-thickness bites of the gastric and tracheal part with 2-0 Vicryl polyglactin 910 continuous sutures. The patient was discharged in a good general condition and is alive without recurrence.

Discussion

This case is one of our personal experiences of 15 cases of total esophagectomy, pharyngectomy, laryngectomy, and gastric pull-up operations. A fistula between the respiratory and gastrointestinal tracts is a potentially fatal complication requiring early intervention. TGF is an uncommon complication.1Go Recurrence or metastatic cancer must be ruled out. The patient’s general condition and nutritional status must be optimized. Preoperative radiotherapy and difficulty with intubation were possible factors.4Go The most common site of TGF is the membranous part of trachea. The blood supply of the trachea, which is segmental and enters laterally, must be preserved. We think that there was dehiscence of the suture line clips at the cardia site of stomach (Figure 1, A).

Single-stage repair of TGF gave excellent results without recurrent fistula.

Supplementary data

Footnotes


Formula

Video clip is available online.

References

  1. Marty-Ane’ C, Prudhome M, Fabre J, Domergue J, Balmes M, Mary H. Tracho-esophagogastric anastomosis fistula: a rare complication of esophagectomy. Ann Thorac Surg 1995;60:690-693.[Abstract/Free Full Text]
  2. Poje CP, Keane W, Atkins JP. Tracheo-gastric fistula following gastric pull-up. Ear Nose Throat J 1991;70:848-850.[Medline]
  3. Kalm’ar K, Molnar T, Morgan A, Horva’th O. Non-malignant (TGF) following oseophagectomy for cancer. Eur J Cardiothorac Surg 2002;18:363-365.
  4. Pac M, Basoglu A, Yediyildiz S, Yekeler I, Yilmaz A. Gastro-tracheal fistula as a result of radiotherapy after transhiatal esophagectomy. Ann Thorac Surg 1991;51:696-697.[Free Full Text]




This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Fayoumi, S.
Right arrow Articles by Sawalhi, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Fayoumi, S.
Right arrow Articles by Sawalhi, S.
Related Collections
Right arrow Trachea and bronchi

HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS