Acquired benign esophago-airway fistulas

Abstract

Materials and methods: Over a period of 25 years, 35 patients with acquired benign esophago-airway fistulas were treated. Only two of them were female. The etiology of the communications was corrosive burns, penetrating wounds, postoperative and endoscopic lesions, esophageal diverticula, prolonged ventilatory assistance, pleural empyema and foreign bodies. Radical operative treatment was performed in 31 cases. In four of these the procedure was palliative, because of poor general condition and lung complications. The operative approach was chosen after precise endoscopic and contrast X-ray examinations. A cervical approach with partial median sternotomy to the third intercostal space was performed in 19 patients. In the rest of the patients a thoracotomy was performed. Simple excision of the fistula, longitudinal suture of the trachea and horizontal suture of the esophagus was the method of choice in nine patients. A flap from the left sternocleidomastoid was additionally interposed in front of the esophagus in 12 patients. In six cases circular resection, reconstruction of the trachea and plastic suture of the esophagus were performed. Esophagectomy with ensuing colon substitution was necessary in four patients.

Results: Excellent or good results were obtained in 29 of the 31 patients operated on. We had two deaths in the early postoperative period (6.8%) due to lung complications in patients with chemical burns of the esophagus. The operated patients were followed up for period ranging from 3 to 20 years.

Conclusion: Acquired esophago-respiratory fistulas require emergency surgical treatment. The proper choice of operative approach is largely dependent on the precise diagnosis. Preoperative intensive care and metabolic balance are important factors in this report. Radical operative treatment depends on the basic disease, local inflammation and lung complications.