Surgical Management of Tracheocutaneous Fistula

1998 ◽  
Vol 77 (7) ◽  
pp. 534-537 ◽  
Author(s):  
Dean A. Drezner ◽  
Harry Cantrell
Keyword(s):  
Medical Center ◽  
Surgical Approaches ◽  
Fistula Closure ◽  
Operative Techniques ◽  
Tracheotomy Tube ◽  
Respiratory Compromise ◽  
Closure Technique ◽  
Healing By Second Intention ◽  
Tracheocutaneous Fistula ◽  
Flap Closure

Tracheocutaneous fistula (TCF) is a complication of tracheotomy that adds a difficult and bothersome aspect to the patient's care and may exacerbate respiratory disease. Closure of the fistula is recommended, but complications associated with fistula closure include pneumothorax and respiratory compromise. Several surgical approaches have been advocated in the literature. We reviewed the operative techniques and outcomes of TCF closures performed at Cooper Hospital/University Medical Center between February 1990 and April 1995. Direct, or flap, closure of large tracheocutaneous fistulas was associated with significant complications and morbidity. Therefore, the closure technique was modified so that we now recommend, in patients with large tracheocutaneous fistulas (a defect of the anterior tracheal wall of ≥4 mm diameter), excision of the fistula, replacement of the tracheotomy tube and healing by second intention after a short recannulation period. No complications have occurred since this closure technique was adopted.

An Eight-Year Analysis of Surgical Morbidity and Mortality: Data and Solutions

2006 ◽  
Vol 72 (11) ◽  
pp. 1070-1081
Author(s):  
Michael A. Goldfarb ◽  
Thomas Baker
Keyword(s):  
Surgical Outcome ◽  
Medical Center ◽  
Morbidity And Mortality ◽  
Mortality Data ◽  
Time Process ◽  
Operative Techniques ◽  
Barriers To Adoption ◽  
Surgical Morbidity ◽  
Technical Complications ◽  
Common Problems

In this article, a reproducible process for presenting, analyzing, and reducing early and late surgical morbidity and mortality (M&M) is detailed. All M&M cases presented from 1998 through 2005 at Monmouth Medical Center were categorized. Residents and nurses were empowered to report the complications. The five major categories were overwhelming disease on admission, delays in treatment, diagnostic or judgment complications, treatment complications, and technical complications. From the 53,541 operations performed over 8 years, 714 patients were presented, which included 147 deaths and 1,132 category entries. The most common problems were technical complications in 474 (66.4%) patients. The data have generated actionable solutions, many with low barriers to adoption, resulting in safer, less expensive surgical management. Surgical outcome benchmarks have been established and are used for credentialing surgeons. The “Hostile Abdomen Index” has been developed to assess the safest choice for abdominal operative access, pre- and intraoperatively. We explained the real-time process that generated solutions for the entire department as well as changes relevant to residency training and individual operative techniques.

Office-Based Anesthesia

2011 ◽  
pp. 228-235
Author(s):  
Laurence M. Hausman
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Small Community ◽  
Respiratory Compromise ◽  
Tertiary Care Medical Center ◽  
Difficult Airways ◽  
Risk Of Exposure ◽  
American Society ◽  
American Society Of Anesthesiologists

There are many advantages to office-based procedures for both patients and practitioners. The patient is afforded more privacy with a more personal experience, as well as decreased facility fee if paying out of pocket and less risk of exposure to nosocomial infections. The practitioner will generally have improved ease in scheduling of cases, the convenience of being able to perform surgery within the same office as preoperative and postoperative care, and in some cases will receive an enhanced professional fee.5 An office practice cannot provide the same level of care as a tertiary care medical center or even a small community hospital. For this reason, not all surgical procedures or patient populations are appropriate for this venue. For example, procedures associated with large fluid shifts, blood loss, excessive postoperative pain, or respiratory compromise should continue to be performed in the hospital setting. Likewise, patients with significant comorbidities, potentially difficult airways, or those at risk for aspiration should not be considered suitable candidates for an office-based procedure. The American Society of Anesthesiologists (ASA) has published specific recommendations regarding what types of surgery and patient populations should be excluded from this venue.6

scholarly journals Delayed complication of tracheocutaneous fistula closure with severe compromising subcutaneous emphysema

2019 ◽  
Vol 12 (6) ◽  
pp. e229526 ◽  
Author(s):  
Robert J Lewis ◽  
Ari G Mandler ◽  
Geovanny Perez ◽  
Pamela A Mudd
Keyword(s):  
Subcutaneous Emphysema ◽  
Complete Resolution ◽  
Lessons Learned ◽  
Fistula Closure ◽  
Significant Complication ◽  
Secondary Intention ◽  
Delayed Complication ◽  
Tracheocutaneous Fistula ◽  
One Year

We report a significant complication after tracheocutaneous fistula (TCF) excision with closure by secondary intention in a 4-year-old boy who had been tracheostomy dependent since infancy. He had a persistent 3 mm TCF one year after decannulation. On postoperative day 2 the patient developed profound subcutaneous emphysema and pneumomediastinum. He was extubated after 2 days and discharged from the hospital on postoperative day 7. At follow up he had complete resolution of subcutaneous emphysema and complete closure of the TCF. The main methods of TCF closure and management of subcutaneous emphysema are discussed along with the lessons learned from this case.

Perioperative Outcomes of Radical Trachelectomy in Early-Stage Cervical Cancer: Vaginal Versus Laparoscopic Approaches

2015 ◽  
Vol 25 (6) ◽  
pp. 1051-1057 ◽  
Author(s):  
Aera Yoon ◽  
Chel Hun Choi ◽  
Yoo-Young Lee ◽  
Tae-Joong Kim ◽  
Jeong-Won Lee ◽  
...  
Keyword(s):  
Blood Loss ◽  
Tumor Size ◽  
Early Stage ◽  
Medical Center ◽  
Intraoperative Complications ◽  
Outcome Data ◽  
Perioperative Outcomes ◽  
Surgical Approaches ◽  
Radical Trachelectomy ◽  
Gynecology And Obstetrics

ObjectiveThis study aimed to compare the laparoscopic-assisted radical vaginal trachelectomy (LARVT) and laparoscopic radical trachelectomy (LRT) surgical approaches and provide outcome data on patients who have undergone radical trachelectomy.MethodsWe identified patients who had undergone LARVT or LRT at Samsung Medical Center between January 2005 and March 2013.ResultsA total of 38 patients were identified, and 21 patients had undergone LARVT, whereas 17 patients had undergone LRT. The median age was 32 years for both groups. Most of the patients had a squamous cell carcinoma (68.4%) and International Federation of Gynecology and Obstetrics stage IB1 disease (76.3%). Twenty (52.6%) of 38 patients had tumor size greater than 2 cm. There were no significant differences between groups in the baseline characteristics except for the tumor size. Patients undergoing LRT had significantly larger tumor size than patients undergoing LARVT (median tumor size, 2.7 cm [range, 1.2–3.7] vs 2.1 cm [range, 0.4–3.0],P= 0.032). Perioperative outcomes were similar between groups except for the decline of hemoglobin after surgery. The median decline of hemoglobin indicating blood loss was significantly smaller in the LRT group than in the LARVT group (1.8 g/dL [range, 0.5–3.5] vs 2.6 g/dL [range, 0.7–6.2],P= 0.017). Intraoperative complications occurred in 2 patients (9.5%, 2/21) in LARVT group. Although 52.6% of tumors were larger than 2 cm, recurrence occurred only in 3 (7.9%) patients who underwent LARVT.ConclusionsThe study shows the feasibility of LRT, with the advantage of reduced blood loss. The LRT could be an alternative option for patients with large tumors. Further researches are needed to investigate the long-term outcomes.

scholarly journals Classification and Stages of Middle Ear Cholesteatoma at the Southern Philippines Medical Center Using the European Academy of Otology and Neurotology / Japan Otological Society (EAONO / JOS) System

2021 ◽  
Vol 36 (1) ◽  
pp. 24
Author(s):  
Dominador Toral ◽  
Chris Robinson Laganao
Keyword(s):  
Middle Ear ◽  
Medical Center ◽  
Case Series ◽  
Stage Iv ◽  
Surgical Approaches ◽  
Middle Ear Surgery ◽  
Retraction Pocket ◽  
European Academy ◽  
Subperiosteal Abscess ◽  
Middle Ear Cholesteatoma

ABSTRACT Objective: To determine the stage of middle ear cholesteatoma of patients who underwent middle ear surgery at the Southern Philippines Medical Center from January to December 2019, based on European Academy of Otology and Neurotology / Japan Otological Society (EAONO/ JOS) system. Methods: Design: Case Series Setting: Tertiary Government Hospital Participants: A total of 42 charts were included in the study   Results: Of the 42 cases evaluated, congenital cholesteatoma was seen in 4 while acquired cholesteatoma was noted in 38, (further subdivided into 34 retraction pocket cholesteatoma and 4 non-retraction pocket/traumatic cholesteatoma). A majority (57%) had Stage II cholesteatoma (mass occupying at least two sub-sites in the middle ear) at the time of surgery. Eight (19%) had stage I cholesteatoma (confined to one sub-site), five (12%) had stage III cholesteatoma evidenced by extracranial complications such as subperiosteal abscess and erosion of the semi[1]circular canals. Stage IV cholesteatoma was seen in 5 (12%) presenting with intracranial abscess. Canal wall down mastoidectomy was the most common surgical approach performed. The sinus tympani (S2 ) was the most commonly involved difficult to access site across all classifications of middle ear cholesteatoma (60%). Conclusion: Our study provided an initial profile of the stages and severity of middle ear cholesteatoma in our institution based on actual surgical approaches. Such a profile can be the nidus for a database that can help us to understand disease prevalence and compare local surgical practices with those in the international community.

scholarly journals Cost-effectiveness of different surgical treatment approaches for early breast cancer: a retrospective matched cohort study from China

2020 ◽  
Author(s):  
Qing Yang ◽  
Xiaorong Zhong ◽  
Wei Zhang ◽  
Ting Luo ◽  
Ping He ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cost Effectiveness ◽  
Surgical Treatment ◽  
Early Breast Cancer ◽  
Medical Center ◽  
Treatment Options ◽  
Academic Medical Center ◽  
Breast Conserving Surgery ◽  
Surgical Approaches ◽  
Treatment Approaches

Abstract Background Both breast-conserving surgery and breast reconstruction surgery are less popular in China, although they can improve patients' quality of life. The main reason comes from the economy. There is currently no economic evaluation of different surgical treatment options for early breast cancer. Our study aimed to evaluate the long-term cost-utilities of different surgical treatment approaches for early breast cancer. The surgical approaches are including mastectomy(MAST), breast-conserving therapy(BCT), and mastectomy with reconstruction (MAST+RECON). Methods We applied the propensity score matching method to perform a 1: 1 match on patients undergoing these three types of surgery in a tertiary academic medical center from 2011 to 2017 to obtain a balanced sample of covariates between groups. A Markov model was established. Clinical data and cost data were obtained from the medical records. Health utility values were derived from clinical investigations. Strategies were compared using an incremental cost-effectiveness ratio (ICER). Results The total cost of MAST, MAST+RECON and BCT was $35,282.24, $69,428.82 and $73,661.08, respectively. The discounted quality-adjusted life year(QALYs) were 17.94, 18.71 and 20.49, respectively. Compared with MAST, MAST+RECON and BCT have an ICER of $106708.06/QALY and $15050.53/QALY, respectively. The ICER of BCT vs. MAST was less than the threshold of $27,931.04. The reliability and stability of the results were confirmed by Monte Carlo simulation and sensitivity analysis. Conclusions We believe that in the context of the limited resources in China, after comparing the three surgical approaches, BCT is the more cost-effective and preferred solution.

Pediatric tracheocutaneous fistula closure following tracheostomy decannulation

2019 ◽  
Vol 125 ◽  
pp. 122-127 ◽  
Author(s):  
Benjamin L. Wisniewski ◽  
Emily L. Jensen ◽  
Jeremy D. Prager ◽  
Todd M. Wine ◽  
Christopher D. Baker
Keyword(s):  
Fistula Closure ◽  
Tracheocutaneous Fistula
Sign in / Sign up

Export Citation Format

Share Document