Surgical management of large tracheoesophageal fistula in infants after button battery ingestion

Author:

Avsar Murat1,Goecke Tobias1,Keil Oliver2,Koeditz Harald3,Schwerk Nicolaus4,Kuebler Joachim F5,Horke Alexander1ORCID,Warnecke Gregor1,Haverich Axel1,Ure Benno5,Zardo Patrick1

Affiliation:

1. Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School , Hannover, Germany

2. Department of Anesthesiology, Hannover Medical School , Hannover, Germany

3. Department of Pediatric Cardiology and Intensive Care, Hannover Medical School , Hannover, Germany

4. Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School , Hannover, Germany

5. Department of Pediatric Surgery, Hannover Medical School , Hannover, Germany

Abstract

AbstractOBJECTIVESIn recent years, an increase in severe and even fatal outcomes related to oesophageal or airway button battery (BB) ingestion by infants and small children has been reported. Extensive tissue necrosis caused by lodged BB can lead to major complications, including tracheoesophageal fistula (TEF). In these instances, best treatment remains controversial. While small defects may warrant a conservative approach, surgery often remains inevitable in highly complex cases with large TEF. We present a series of small children that underwent successful surgical management by a multidisciplinary team in our institution.METHODSThis is a retrospective analysis of n = 4 patients <18 months undergoing TEF repair from 2018 to 2021.RESULTSSurgical repair under extracorporeal membrane oxygenation (ECMO) support was feasible in n = 4 patients by reconstructing the trachea with decellularized aortic homografts that were buttressed with pedicled latissimus dorsi muscle flaps. While direct oesophageal repair was feasible in 1 patient, 3 required esophagogastrostomy and secondary repair. The procedure was completed successfully in all 4 children with no mortality and acceptable morbidity.CONCLUSIONSTracheo-oesophageal repair after BB ingestion remains challenging and is associated with major morbidity. Bioprosthetic materials in conjunction with the interposition of vascularized tissue flaps between trachea and oesophagus appear to be a valid approach to manage severe cases.

Funder

departmental resources

Publisher

Oxford University Press (OUP)

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,General Medicine,Surgery

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