Surgical management of acquired non-malignant tracheo-esophageal fistulas

J Cardiovasc Surg (Torino). 2001 Apr;42(2):257-60.

Abstract

Background: The aim of this study was to evaluate the results of one-stage surgical management of acquired non-malignant tracheo-esophageal fistulas (TEF).

Methods: Six consecutive patients, 2 men and 4 women with median age of 65 (range 34-71) years had tracheo-esophageal fistulas resulting from a median of 33 (range 20-86) days of intubation via oro-tracheal or tracheostomy tubes. Median TEF length was 2.6 (range 1.8-3.5) cm and the defect was associated with a tracheal stenosis near or immediately below the stoma in 4 cases (66%). Tracheal resection and anastomosis with primary esophageal closure was carried out in 4 patients; direct closure of the tracheal and esophageal defects with muscle flap interposition was performed in 2 patients: tracheal stoma was left in site because of the high risk of postoperative respiratory insufficiency related to chronic obstructive pulmonary disease.

Results: All six patients had complete control of the TEF. One perioperative death occurred on day 27 (16%) related to the recurrence of endocranial bleeding. The 5 long-term survivors were routinely submitted to tracheo-bronchoscopic control and only one (20%) revealed granulation tissue at the suture line requiring two consecutive bronchoscopic removals.

Conclusions: Postintubation tracheoesophageal fistula is usually best treated with one-stage surgical procedure: which preferably consists of tracheal resection and anastomosis and primary esophageal closure.

MeSH terms

  • Aged
  • Female
  • Humans
  • Intubation, Intratracheal / adverse effects
  • Male
  • Surgical Flaps
  • Tracheoesophageal Fistula / etiology
  • Tracheoesophageal Fistula / surgery*
  • Tracheostomy / adverse effects