C Palanivelu, MS, FACS, FRCSEd, DSc, R Parthasarathi, MS, FMAS, S Rajapandian, MS, FRCS, FMAS, P Senthilnathan, MS, FMAS, DNB, P Praveen Raj, MS, FMAS, N Ramesh, MS, M Bharath Cumar, MS, S Saravana Kumar, MS. GEM Hospital & Research Centre
Background: Acquired non-malignant is an uncommon disorder with a high degree of morbidity and mortality. Etiology includes iatrogenic injury, prolonged ventilation, high endotracheal/tracheostomy tube cuff pressure, pulmonary tuberculosis, corrosive ingestion etc. Management options include interventional treatment such as esophageal and/or airway stenting, sealing the fistula tract with glue, fibrin plug or endoclips, and laser or argon plasma coagulation (APC). Surgical options include direct closure of the tracheal and oesophageal defects with or without a muscle/omental flap, tracheal resection and anastomosis with primary esophageal closure, esophageal diversion etc. Here, we describe a novel technique for treatment of acquired non-malignant TEF – Thoracoscopic stapler division of fistula tract.
Case 1: 56 years old male, with previous history of pulmonary tuberculosis, presented with complaints of cough following food intake since 25-30 years. Evaluation elsewhere revealed TEF followed by three failed attempts of endoscopic APC with clipping. OGD scopy and MDCT chest confirmed presence of tracheo-esophageal fistula with fistulous opening at 28cms in esophagus. He underwent thoracoscopy in semiprone position. Following esophageal mobilization, fistula tract was located with the help of intraoperative endoscopy, dissected all around and divided with 45mm white linear stapler. Pleural flap was raised and interposed between two divided ends.
Case 2: 24 years male, on ATT for tubercular lymphadenitis since 4 months, developed violent cough on oral intake since 2 months associated with vomiting and was diagnosed to have left broncho-esophageal fistula (1cm long, 4mm wide). Covered SEMS was placed endoscopically thrice which migrated repeatedly with recurrence of symptoms. Following evaluation and optimization, he underwent thoracoscopic mobilization of fistula tract and division with 60mm white stapler.
Results: Uneventful recovery – ICU stay 1&3 days and post-operative stay 5&6 days respectively, no morbidity. Follow-up is 9 and 6 months respectively. CT with oral contrast at 3 months showed no evidence of recurrence.
Discussion: This is a novel approach or select patients with TEF. Experience in thoracoscopy, acquired through resection of esophageal malignancy, was utilized for treating this benign condition. This surgical approach was found to be associated with minimal morbidity, minimal analgesic requirements, short hospital stay, and excellent cosmesis. Recurrence rate was nil.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 79484
Program Number: V036
Presentation Session: Thursday Exhibit Hall Video Presentations Session 2 (Non CME)
Presentation Type: EHVideo