AB231. SOH21AS233. Total oesophagectomy and gastric pull-up as definitive management for a tracheo-oesophageal fistula following secondary puncture in an irradiated laryngectomee: a case report
Head & Neck Poster Session

AB231. SOH21AS233. Total oesophagectomy and gastric pull-up as definitive management for a tracheo-oesophageal fistula following secondary puncture in an irradiated laryngectomee: a case report

Anna McCollum, Michael Walsh, John Kinsella

Department of Otolaryngology/Head and Neck Surgery, St James’ Hospital, Dublin, Ireland


Abstract: The use of a tracheo-oesophageal puncture (TEP) following total laryngectomy allows for speech rehabilitation and a huge improvement in quality of life for laryngectomees. However in the literature, tracheo-oesophageal fistula enlargement occurs in over 15% of cases, more commonly following primary TEP, which can lead to leakage of saliva, food contents and subsequent aspiration. We present the case of a 65-year-old male referred to a tertiary care centre for repair of a large tracheo-oesophageal fistula, following total laryngectomy and bilateral neck dissections with adjuvant radiotherapy 4 years prior. A secondary TEP led to a 2 cm × 1.5 cm fistula in the tracheo-oesophageal wall, causing recurrent aspiration pneumoniae. Initial management was a myogenous pectoralis rotational flap with three-layer closure. Post-op wound swabs confirmed MRSA, leading to extensive wound and flap breakdown, and ultimately the fistula enlarged to greater than prior. Definitively, a modified pharyngectomy, oesophagectomy & gastric pull-up with a pectoralis major myocutaneous flap was carried out. There were no intraoperative complications. Following formal swallow assessment with speech and language therapy on post-operative day 15, the patient was established on level 0 fluids and level 4 solids by day 18 and subsequently discharged home on day 36. This case demonstrates total oesophagectomy and gastric pull-up as successful definitive management for repair of a complex tracheo-oesophageal fistula in an irradiated patient. Coordination with Upper GI surgeons effectively led to optimal single institution management in this unique case.

Keywords: Gastric-pull up; laryngectomy; oesophagectomy; tracheo-oesophageal fistula; tracheo-oesophageal puncture


Acknowledgments

Funding: None.


Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/map-21-ab231). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.


doi: 10.21037/map-21-ab231
Cite this abstract as: McCollum A, Walsh M, Kinsella J. AB231. SOH21AS233. Total oesophagectomy and gastric pull-up as definitive management for a tracheo-oesophageal fistula following secondary puncture in an irradiated laryngectomee: a case report. Mesentery Peritoneum 2021;5:AB231.