Four for one

Successful cooperation between the Gastroenterology Institute, the Ear-Nose-and-Throat Unit, the Cardiology Division and the Anesthesiology Division at Hillel Yaffe Medical Center led to a unique and sophisticated solution for closing a fistula - an opening created between the trachea and the esophagus.

This is a procedure that was performed for the first time at Hillel Yaffe Medical Center and has only been performed several times in Israel and around the world. It uses a cardiology device to close the fistula. It is a new and sophisticated breakthrough, which will make it possible to provide patients with professional and innovative treatment, and specifically, will prevent the need for complex surgery in the future, which poses numerous risks.

From right to left: Dr. Chakim Abu-ras, Dr. Yael Kopelman, Dr. Aharon Frimerman and Dr. Itzhak Braverman

This cooperation was born out of the need to find a creative solution for a patient who suffered from a fistula following lengthy resuscitation several months ago, and after which he required an opening in the trachea and a permanent ventilator through this opening. After a lengthy stay at a geriatric medical facility, the patient came to Hillel Yaffe Medical Center with a fever, while he was sedated and intubated. As part of the complex care he received, imaging was done and a fistula found, which led the air from intubation to inflate the stomach and, at the same time, for the gastric juices to enter the trachea, which leads to pneumonia.

There are several options for treating a fistula, including use of fibrin glue and clips, but for the most part, these solutions are not optimal, and patients have to undergo surgery. “In this case, operating on the patient would have been very dangerous, because of his complex medical condition. We had no choice but to find a creative solution to close the hole. Thanks to successful cooperation between four departments - this was possible. We used a stent that cardiologists use to close a hole in the septum with a unique technique that has only been performed very few times in Israel and worldwide,” said Dr. Yael Kopelman, Director of the Gastroenterology Institute at Hillel Yaffe Medical Center.

The four department directors joined forces in the Gastroenterology Institute’s procedure room to perform the procedure: Dr. Yael Kopelman - Director of the institute and Dr. Itzhak Braverman - Director of the ENT Unit, were responsible for connecting the stent to both side of the hole, each in their area of expertise. Dr. Chakim Abu-ras - Director of the Anesthesiology Department, oversaw the patient’s condition with respect to the anesthesia, and Dr. Aharon Frimerman - Director of the Catheterization Unit placed the stent. The procedure was very successful.

“Up until now, most patients had to have surgery to close the hole performed by a physician specializing in thoracic surgery. Thanks to fantastic cooperation between the doctors from the various fields, in the future we will be able to provide quick and professional treatment, without the need for complicated surgery that involves far greater risks,” said Dr. Kopelman.