QUAD #6 Slide Tracheoplasty for TEF, Otolaryngology Approach with Dr. Mike Rutter

Slide tracheoplasty can be used as a method of repairing challenging tracheoesophageal fistulas

In a case with complete tracheal rings and TEF, both conditions were repaired simultaneously because there was no other option

The slide tracheoplasty technique involves transecting the trachea above and below the hole with a bevel to avoid losing too much trachea

Part of the trachea is used to repair the esophagus, then the trachea is slid over the top of it, often with a periosteal interposition graft

In the slide tracheoplasty repair, a flap of trachea is sewn onto the esophagus so the front wall of the esophagus becomes a piece of trachea, using a quick running suture technique with 4-0 PDS

When the distance between trachea and esophagus is large, using nerve hooks and slowly tightening multiple throws brings the structures together

In the Swedish patient case, esophagoscopy at one month post-op showed the suture line where trachea was sewn to esophagus with the front wall being a piece of trachea

The Swedish patient returned to eating and drinking everything despite having a very short trachea

In the 4-year-old case, initial stabilization was achieved by placing an esophageal stent, which did not fix the holes but eliminated the mediastinal communication

A transsternal, transtracheal approach provides fantastic exposure to the esophagus

Tibial periosteum serves as a good interposition graft

Periosteum is effective at protecting one lumen from another

Slide tracheoplasty is not appropriate for every TEF case, but it is useful to know the option is available