Tracheoesophageal fistulas

Abstract

Tracheoesophageal fistula is an uncommon clinical problem, and can be either congenital or acquired in origin. In this report, we present our experience in the management of 41 patients with tracheoesophageal fistula (28 male, 13 female; age ranging from 8 to 69 years) who were seen during the period spanning 1968 to 1989 at the National Research Center of Surgery, Moscow. During this time frame fewer malignant and correspondingly more posttraumatic and postoperative fistulas were observed. The most common clinical findings were cough associated with eating, production of sputum mixed with food, and weight loss with profound weakness. In the vast majority of patients, diagnosis was made using radiologic contrast studies, with endoscopic assessment being occasionally necessary. We classify our surgical approaches as "radical" (the isolation and ablation of the communication), "conditionally radical" (implying creation of a neoesophagus or thoracoplasty with muscle flap obliteration of the fistula and associated chronic empyema cavity), or "palliative" (usually entailing gastrostomy alone). Of the 32 patients undergoing surgical treatment in this series, 21 underwent radical or conditionally radical procedures; there was no operative mortality, and long-term follow-up shows that 19 of the 20 long-term survivors report satisfactory, good, or excellent status. This report summarizes the indications, timing, technique, and results of the various surgical approaches, and also delineates measures for the prevention of postoperative tracheoesophageal fistula.