Novel method for refractory tracheoesophageal fistula closure: modified polydioxanone suture mesh with fibrin glue

Abstract

Background and Aims

Refractory tracheoesophageal fistulas (TEFs) are difficult to treat, with high morbidity and mortality associated with surgical re-exploration. Various endoscopic modalities have offered minimally invasive therapeutic options. Tissue adhesive agents with ablation have achieved closure of TEFs with varying success. We adopted a novel method by using modified polydioxanone (PDS) suture mesh with fibrin glue in a child who had previously failed surgical correction twice as well as various endoscopic modalities.

Methods

A 5-year-old child with congenital TEF presented with recurrence after failing multiple surgical and endoscopic attempts at closure. An endoscopic examination revealed a fistula opening with a diameter of 7 mm that was 19 cm from the incisors. We used a modified PDS suture mesh with 3 sessions of fibrin glue application. PDS sutures 3-0 in size were used to knit the tubular mesh after inserting multiple knots. The suture mesh was then placed in the fistula and fixed with clips after ablating the edges with argon plasma coagulation. Subsequently, a double-lumen catheter was used to deliver processed components of fibrin sealant into the fistula tract to form the final fibrin clot. Two sessions of repeat ablation and fibrin glue application were done at 2-week intervals.

Results

Successful closure of the TEF was achieved with PDS suture mesh and 3 sessions of fibrin glue application over a total treatment duration of 8 weeks.

Conclusions

A modified PDS suture mesh with fibrin glue application offers an additional modality for endoscopic closure of refractory recurrent TEF. This novel technique is safe, effective, and easily adaptable.