https://doi.org/10.4081/monaldi.2023.2490

The surgical approach of late-onset tracheoesophageal fistula in a tracheostomized COVID-19 patient

Vol. 93 No. 4 (2023)
Submitted: November 22, 2022
Accepted: December 16, 2022
Published: February 7, 2023
Tracheoesaphageal fistula, COVID-19, Tracheal resection and reconstruction, prolonged mechanical ventilation, esophageal repair
Abstract Views: 627
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Authors

Nicola Rotolo
nicola.rotolo@uninsubria.it
https://orcid.org/0000-0003-1325-9284
Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Maria Cattoni
https://orcid.org/0000-0003-3042-2725
Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Silvia De Maio
https://orcid.org/0000-0002-5051-7994
Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Luca Filipponi
Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Pau Mateo-Ramos
Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese, Italy.
Andrea Imperatori
https://orcid.org/0000-0001-6281-1800
Research Center of Minimally Invasive Surgery and Thoracic Surgery, Department of Technological Innovation, Department of Medicine and Surgery, University of Insubria, Varese, Italy.

In the COVID-19 era the tracheal complications due to prolonged mechanical ventilation have significantly increased. Acquired tracheoesophageal fistula is one of those in ventilated COVID-19 patients. Thus, the knowledge of their management in such fragile patient is crucial. We report a case of tracheoesophageal fistula in a 56-year-old female under prolonged mechanical ventilation for COVID-19 bilateral pneumonia and discuss its management. A surgical approach was proposed. By a collar-shaped transverse cervicotomic access, we transected the trachea at level of fistula en-bloc with the tracheostoma. The esophageal lesion was longitudinally repaired in two-layers. Protective left strap muscle was sandwiched between esophagus and trachea. The tracheal end-to-end anastomosis was completed without a re-tracheostoma. Even if surgical approach of tracheoesophageal fistula in COVID-19 patients has not been tested before, surgery remains the treatment of choice according to the multidisciplinary board.

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How to Cite

Rotolo, Nicola, Maria Cattoni, Silvia De Maio, Luca Filipponi, Pau Mateo-Ramos, and Andrea Imperatori. 2023. “The Surgical Approach of Late-Onset Tracheoesophageal Fistula in a Tracheostomized COVID-19 Patient”. Monaldi Archives for Chest Disease 93 (4). https://doi.org/10.4081/monaldi.2023.2490.
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