Author/Editor		Sok, Miha; Orel, Janez; Hrabar, Bogo; Jerman, Jože
Title		Kirurgija traheoezofagealnih fistul po dolgotrajni intubaciji in mehanični ventilaciji
Translated title		Surgery of tracheoesophageal fistulas following long-term intubation and mechanical ventilation
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 62, št. Suppl 2
Publication year		1993
Volume		str. 9-12
Language		slo
Abstract		Background. In the paper the authors describe the risk factors for the development of a tracheo-esophageal fistula (TEF) and report the results of surgical treatment. Methods. Ten patients with TEF were treated between 1970 and 1991. Fistula appeared on average 37 (12-75) days after the institution of treatment with intubation and controlled ventilation for various conditions. All the patients had some kind of brain injury. They had a nasogastric tube (Ch more than 17) in place while being ventilated. The TEF was established by bronchoscopy in 6/10 patients and by esophagoscopy in 10/10. Five patients had supraostial tracheal stenosis and one had pronounced tracheomalacia. The fistula measured from 1 to 4 cm in length and its proximal margin was located at a distance of 15 to 19 cm from the upper teeth. The treatment consisted of two stages.While still receiving ventilatory support, the patients underwent procedures for esophageal diversion: gastrostomy, jejunostomy and tracheostomy were done in eight cases, and transhiatal resection of the oesophagus with cervical oesophagostomy and jejunostomy in two. The second stage followed when the patient had been weaned from the ventilator. In eight patients the operation was done via a neck incision and in two via a right thoracotomy and sternotomy. Direct suture closure of the oesophagus with or without muscle interposition was used in eight patients, gastroplasty in one and coloplasty in one. Tracheal resection was performed in five patients with supraostial stenosis. Two patients (20 per cent ) died. Seven patients have no swallowing difficulty. The female patient who underwent gastroplasty has a severe gastro-oesophageal reflux. Of the eight living patients one has a tracheal stoma. Conclusions. TEF develops as a result of prolonged intubation and controlled ventilation. The risk factors include brain injury and placement of a nasogastric tube larger than Ch 17. The diagnosis is made by esophagoscopy.(trunc.)
Descriptors		TRACHEOESOPHAGEAL FISTULA RISK FACTORS RESPIRATION, ARTIFICIAL INTUBATION, INTRATRACHEAL