Endoscopic treatment of tracheo-oesophageal fistulae: an innovative procedure

Abstract

Surgical repair of tracheo-esophageal fistula is a complex procedure that can be challenging in compromised patients.Surgical repair remains the gold standard,however,in compromised patients,may be difficult or dangerous.We present our experience with a totally endoscopic approach based on the suture of a fistula with resorbable stitches.The procedure was performed in a young patient with a congenital tracheo-esophageal fistula located in the middle third of the trachea 2cm long.The patient had rigid bronchoscopy.A rigid telescope (Storz)connected to a camera and a rigid aspirator were inserted through the tube.The fistula was exposed and sutured by means of resorbable stitches (Vycryl© 3.0),using a long needle holder.The knots were tied outside of the tracheoscope and were pushed down with a knot pusher.The surgical thread was cut with a contact Yag laser fiber (Figure 1).The procedure lasted 40 min, and the patient was discharged after 24 h.He was able to eat normally the same day.After 3 months, the patient was in excellent condition, free of cough and of pulmonary symptoms.A monthly endoscopic examination and CT scan confirmed the stability of the suture,and no recurrence of the fistula was observed.Our experience demonstrates that an endoscopic suture of the fistula is feasible and may be effective for palliation.Long-term follow-up will indicate whether this procedure may also be considered a definitive intervention.