Surgical correction of tracheo-esophageal obstructions provides excellent freedom-from-re-intervention during long-term follow-up

Objectives: Surgical correction of complex tracheo-esophageal obstructions due to vascular rings and slings has long been considered as ultima ratio. It was unclear whether patients would benefit in the long-term or if relief of symptoms was only temporary. Aim of the current study was to provide long-term follow-up beyond infancy.

Patients and methods: Data were retrospectively collected from all patients that underwent surgery for complex tracheo-esophageal obstructions due to vascular rings and slings at this institution since 1992.

Results: Twenty-seven patients were identified and provided a mean follow-up of 9.4y. Two patients were lost to follow-up. Diagnosis was double aortic arch (10 [40%]), right-sided aortic arch (6 [24%]), A. lusoria (3 [12%]), pulmonary artery sling (2 [8%]) and miscellaneous (4 [16%]). Tracheo- or bronchomalacia was present in 10 [40%] and 3 [12%] patients, respectively. Two-thirds of patients (16 [64%]) suffered from associated cardiac defects.

Two-thirds of patients (17 [67%]) had onset of symptoms shortly after birth whereas one-third (8 [33%]) presented later in childhood. Diagnosis was established at an average age of 6y (0–14y). Average time between onset of symptoms and referral for surgery was 4.1y. Operative mortality was zero. Technical success was confirmed by perioperative bronchoscopy. Only 4 patients demonstrated residual symptoms during follow-up leading to re-operation in 2 patients due to persistent dysphagia and recurrent tracheal stenosis, respectively.

Conclusion: Patients with complex tracheo-oesophageal lesions due to vascular malformations benefit from surgical intervention in the long-term. The current data suggests that surgery is a viable treatment option in this patient population and should not only be considered as a bail-out.