Surgical Management Of 3 Cases With Huge Tracheoesophageal Fistula With Esophagus Segment in situ As Replacement Of The Posterior Membranous Wall Of The Trachea.

OBJECTIVE:Tracheoesophageal fistula (TEF) is an uncommon and potentially life-threatening complication of blunt chest trauma. The objectives of this report are to describe our surgical experience in three patients with huge TEF and to evaluate the short-term results of surgical management in this potentially life-threatening complication of blunt chest trauma. METHODS:Three patients with huge TEF (5.2-7.0 cm in diameter) after blunt chest trauma were kept in supine position, then the neck was excided and esophagus was free, double breasted suture and clench and mutilation were performed successively over the same level of superior aperture of thorax. The thoracic esophagus was then located in situ at the membrane portion where the trachea was incomplete. Meanwhile, the stomach was then freed through a middle abdominal incision and pulled through the posterior tunnel of the sternum to the neck. Last, an anastomosis between esophagus and tubular stomach was performed over left neck. RESULTS:All three patients recovered well after the operation. They were able to take liquids and then solids beginning ten days after the procedure. One year post-operation, they were able to resume normal activity. CONCLUSIONS:The surgical management of patients with huge TEF by esophageal exclusion (cervical gastroesophagostomy) and use of esophagus segment in situ as replacement of the posterior membranous wall of the trachea is feasible.