Surgical management of acquired non-malignant tracheo-esophageal fistulas

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.