Slide Tracheoplasty for the Treatment of Tracheoesophogeal Fistulas
Slide Tracheoplasty for the Treatment of Tracheoesophageal Fistula
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.
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.
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 48±64 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.
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.