[Surgery for recurrent benign tracheoesophageal fistula].

Abstract

Objective: To optimize diagnosis and treatment methods for recurrent TEF based on analysis of extensive clinical experience; to propose preventive strategies reducing postoperative complications.

Material and methods: Treatment outcomes were analyzed in 115 patients with TEF between 2004 and 2023. Of these, 40 (34.8%) ones underwent redo surgeries after previous failed fistula closure. There were 69 surgical interventions including third-time surgeries in 7 patients with repeated recurrences. TEF associated with tracheal cicatricial stenosis (TCS) in 29 (48.3%) cases necessitated concomitant surgical approaches. Treatment method was determined by characteristics of previous interventions and clinical situation.

Results: No mortality was recorded. The most common postoperative complications were purulent-inflammatory processes. Key risk factors for recurrence were TEF associated with TCS and persistent tracheostomy after tracheoplasty with T-tube. Redo surgical interventions, 3-fold attempts of fistula closure, led to complete recovery in some cases.

Conclusion: The study confirms feasibility of radical treatment for recurrent TEF, even in case of significant anatomical and functional alterations. Original strategies for prevention of recurrence and refined surgical indications enhance treatment efficacy. These data can be used to improve clinical guidelines aimed at reducing recurrence rates and achieving better long-term outcomes.