Name of the Procedure:

Surgical Closure Tracheostomy or Fistula; Without Plastic Repair
Common name(s): Tracheostomy closure, Fistula repair

Summary

The surgical closure of a tracheostomy or fistula involves sealing an artificial opening in the trachea without using plastic repair techniques. This surgery is often performed when the need for a tracheostomy (a tube placement) or fistula (an abnormal connection) has ceased.

Purpose

This procedure addresses the medical condition of a persistent tracheostomy or fistula that is no longer needed for breathing support or has resulted in complications. The goal is to close the opening to prevent infections, normalize breathing, and restore the function and appearance of the neck.

Indications

• Resolution of the condition that necessitated the tracheostomy
• Persistent air leak or infections from the existing fistula
• Difficulty with speech or swallowing due to the opening

Preparation

• Fasting for 6-8 hours prior to the procedure
• Possible adjustments to regular medications as directed by the physician
• Diagnostic tests such as chest X-ray, CT scan, or bronchoscopy to assess the trachea and surrounding structures

Procedure Description

1. Anesthesia: The patient is placed under general anesthesia to ensure comfort and immobility.
2. Incision: A surgical incision is made around the existing tracheostomy or fistula site.
3. Tissue Aggregation: Surrounding tissues are dissected and mobilized to close the opening.
4. Suturing: The opening is meticulously sutured closed, ensuring that the tracheal integrity is restored.
5. Closure: The external incision is closed with sutures or staples, and a dressing is applied.

Duration

The procedure typically takes between 1 to 2 hours, depending on the complexity of the closure.

Setting

This procedure is performed in a hospital operating room or a specialized surgical center.

Personnel

• Surgeon: Performs the procedure
• Nurses: Assist before, during, and after surgery
• Anesthesiologist: Administers anesthesia and monitors the patient

Risks and Complications

• Common risks: Bleeding, infection at the surgical site
• Rare risks: Recurrent fistula formation, airway obstruction, injury to surrounding structures such as the esophagus
• Management: Prompt treatment of any complications, administration of antibiotics if infection occurs

Benefits

• Restoration of normal respiratory function
• Reduction in infection risk
• Improved speech and swallowing functions
• Enhanced cosmetic appearance of the neck area

Recovery

• Post-procedure care: Wound care instructions, pain management medications
• Recovery time: Typically, 1-2 weeks, with restrictions on strenuous activities for 4-6 weeks
• Follow-up: Appointments to check wound healing and ensure no complications

Alternatives

• Continued tracheostomy care: If closure is not feasible or advisable
• Non-surgical closure techniques: Such as using glue or cauterization, though less commonly successful

Patient Experience

The patient can expect to experience some discomfort post-surgery, manageable with prescribed pain medications. Slight swelling and bruising around the site are normal. Full recovery and optimized breathing and functions can be noticed within a few weeks.