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DOI: 10.1055/s-0033-1359117
Treatment of a congenital esophageal fistula by injection of autologous fat
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Publication History
Publication Date:
12 February 2014 (online)
The injection of autologous free fat obtained by suction-assisted lipectomy for the correction of soft tissue defects is a common procedure in plastic surgery. This procedure has also been used to prevent aspiration after vocal fold paralysis [1], and to treat vesicoureteral reflux [2]. Tracheo-esophageal fistula may present as an isolated defect or it may be associated with esophageal atresia. The treatment of congenital tracheo-esophageal fistulas is usually based on surgical procedures [3]. We present a preliminary report of a new endoscopic mode of therapy.
A 55-year-old man suffered from pneumonia and had frequent coughing episodes, especially after swallowing liquids. An orifice was identified by esophagogram ([Fig. 1]) and by endoscopy ([Fig. 2]). Fatty tissue was obtained from the abdominal subcutaneous tissue by a suction-assisted procedure. A total of 60 mL of fatty tissue was obtained. After centrifugation at 3000 rpm for 3 minutes, three layers were clearly visible ([Fig. 3]): at the bottom, a component containing mainly blood residues and serum; in the middle, presumably viable fatty tissue; and, finally, at the top, an oily component that was discarded.
Several passes of a biopsy probe were carried out in order to traumatize the fistulous surface and thus gain adhesiveness. Next, some 15 – 20 mL of the infranatant solution, the presumably viable fatty tissue, was injected using a pressurized injection device and a 17 – to 18-G cannula, to close the fistula.
Ten months later, endoscopic ultrasonography revealed a hyperechoic collection ([Fig. 4]), although a smaller esophageal mucosal orifice still persisted. An additional therapeutic session was decided on.
Two years later ([Fig. 5]), an esophagogram did not reveal a fistula ([Fig. 6]), and the patient remains asymptomatic 11 years later.
This preliminary report confirms that injection of autologous fatty tissue can persist as a long-lasting graft, suggesting several endoscopic applications.
Endoscopy_UCTN_Code_TTT_1AO_2AI
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Competing interests: None
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References
- 1 Sato K, Umeno H, Nakashima T. Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis. Ann Otol Rhinol Laryngol 2004; 113: 87-92
- 2 Matthews RD, Christensen JP, Canning DA. Persistence of autologous free fat transplant in bladder submucosa of rats. J Urol 1994; 152: 819-821
- 3 Genty E, Attal P, Nicollas R et al. Congenital tracheoesophageal fistula without esophageal atresia. Int J Pediatr Otorhinolaryngol 1999; 48: 231-238
Corresponding author
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References
- 1 Sato K, Umeno H, Nakashima T. Autologous fat injection laryngohypopharyngoplasty for aspiration after vocal fold paralysis. Ann Otol Rhinol Laryngol 2004; 113: 87-92
- 2 Matthews RD, Christensen JP, Canning DA. Persistence of autologous free fat transplant in bladder submucosa of rats. J Urol 1994; 152: 819-821
- 3 Genty E, Attal P, Nicollas R et al. Congenital tracheoesophageal fistula without esophageal atresia. Int J Pediatr Otorhinolaryngol 1999; 48: 231-238