Repair of adult benign tracheoesophageal fistulae with absorbable patches: single-center experience

Abstract Background We previously reported on the repair of a wide tracheoesophageal fistula with a bioabsorbable patch. In this paper, we describe a consecutive series of patients operated using the same technique. Methods Data of patients undergoing surgical closure of tracheoesophageal fistula at a single center from 2011 to 2018 were extracted and analyzed. Results An absorbable patch was used in 8 of 23 patients (34.8%) operated for tracheoesophageal fistula during the study period. Etiology of the fistula included postintubation injury (n=6), mediastinal radiotherapy (n=1) and complication of lung resection (n=1). Median fistula size was 27.5 mm (range 15-45 mm). Three patients were approached through cervicotomy and 5 through right thoracotomy. Prosthetic materials consisted of Gore Bio-A tissue reinforcement in 6 patients and poliglactin 910 knitted mesh in 2. In every case, the prosthesis was covered with a pedicled muscle flap. Esophageal defect was treated with primary closure in 7 patients and esophageal exclusion in 1. Fistula recurrence and postoperative death occurred in one patient (12.5%), while 7 patients experienced postoperative complications (87.5%). Five patients resumed oral intake and 3 breathe without a tracheal appliance. Compared to the other patients, in those who underwent repair of their fistula using a prosthesis, median size of the airway defect was larger, morbidity was higher, and the rate of resumption of oral intake was lower. Conclusions Repair of tracheoesophageal fistulae with synthetic prostheses is feasible and might be effective in complex cases. Further research is needed in order to identify the ideal prosthetic material.