Slide Tracheoplasty for the Treatment of Tracheoesophogeal Fistulas

Sunday, October 27, 2013: 10:00 AM
Windermere Ballroom W (Hyatt Regency Orlando, formerly the Peabody)
Michael J. Rutter, BHB, MBChB1, Matthew J. Provenzano, MD1, Daniel von Allmen, MD, FACS, FAAP2, Peter Manning, MD3, R. Paul Boesch, DO4, Philip E Putman, MD5 and Alessandro de Alarcon, MD, MPH1, (1)Cincinnati Children's Hospital, Cincinnati, OH, (2)Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, (3)St. Louis Children's Hospital, (4)Mayo Clinic, (5)Cincinnati Children's Hospital, OH

Slide Tracheoplasty for the Treatment of Tracheoesophageal Fistula

Purpose

Slide tracheoplasty is a surgical technique used to correct various causes of tracheal stenosis.  This report is the first description of this method to correct tracheoesophageal (TE) fistula. The technique divides the trachea, slides the two portions on top of each other, thereby moving the posterior tracheal wall in relationship to the esophagus.  The purpose of this study is to determine the surgical outcome of slide tracheoplasty for the treatment of TE fistula in pediatric patients.

Methods

With approval from the Cincinnati Children's Hospital internal review board, the charts of all pediatric patients (0-18 years old) who had undergone slide tracheoplasty for tracheoesophageal fistula were reviewed.  A retrospective case series was established.  Demographic information, surgical outcomes, and associated findings and anomalies were reviewed.       

Results

Nine patients underwent slide tracheoplasty for correction of TE fistula.  Three patients had had associated esophageal atresia previously repaired.  In five patients the original TE fistula was congenital; other causes included battery ingestion, tracheostomy tube complications, foreign body erosion and an iatrogenic injury.  The average age at repair was 4864 months (range: 1-190).  Four patients had significant additional anatomic abnormalities; one patient had DiGeorge syndrome and a second had VACTERL association.  Six patients had undergone previous TEF repair either open or endoscopically.

Repair occurred either through a cervical incision off bypass (six patients) or through a sternal incision on cardiopulmonary bypass (three patients).  Two patients had sternal periosteum interposed between the esophagus and trachea.  There were no TEF recurrences. A single patient had dehiscence of the tracheal anastomosis and underwent a second procedure.  This patient also had vocal cord paralysis that was likely the result of the initial battery injury; this patient required placement of a tracheostomy.  Previous airway reconstructive procedures did not affect the outcome of the tracheoplasty procedure.  Three patients who were unable to take oral feeds prior to repair were able to upon repair of the fistula, one of whom had a previous atresia repair. 

Conclusion

Slide tracheoplasty is an effective method to treat complex TE fistula. Depending on the location within the trachea, the procedure can be accomplished through a cervical incision with standard respiratory support or through a sternal incision in conjunction with cardiopulmonary bypass.  The procedure was not associated with any recurrences.  Few complications occurred.  This is the first description and presentation of a novel, effective and safe method to treat TE fistula as well as the first reported use of sternal periosteum for the repair of TE fistulaor for use in slide tracheoplasties.