title: Microscopic transtracheal repair of migrating tracheoesophageal fistula.
abstract: OBJECTIVE
  The repair of a persistently leaking migrating tracheoesophageal fistula (TEF) represents a particular challenge owing to the low site of the fistula down to the tracheoesophageal septum (TES). A simple microscopic approach to repair a migrating TEF is described.
  
  
  METHODS
  A description of five cases of migrating TEF. The repair technique and surgical outcome are described in detail.
  
  
  METHODS
  Tertiary care referral hospital.
  
  
  METHODS
  Excision of the fistula tract was done under local anesthesia and microscopic vision using microlaryngoscopic instruments followed by one-layer repair without soft tissue interposition. This technique was used in one patient with a leaking migrating TEF when planned dissection through the TES was abandoned. Subsequently, the technique was employed in four other patients with a similar TEF.
  
  
  METHODS
  Evidence of complete closure of the fistula was assessed clinically 1 week postoperatively. This was followed by methylene blue and Gastrografin swallowing tests. The methylene blue test was repeated after 6 months to exclude recurrence of the fistula and confirm persistent closure.
  
  
  RESULTS
  Complete closure of the fistulae was achieved when assessed clinically and by methylene blue and Gastrografin tests. All patients were discharged on a normal diet. Stable closure was confirmed by the methylene blue test after 6 months. The microlaryngoscopic instruments and surgical microscope have greatly facilitated access and dissection of the migrating fistula with minimum soft tissue loss.
  
  
  CONCLUSIONS
  The described technique is simple, relatively safe, and reproducible for closure of a small migrating TEF. It can also be used to repair small, nonmigrating TEF.
authors.affiliation: Department of Otolaryngology, East Surrey Hospital, Surrey, United Kingdom. msamomar@yahoo.co.uk
authors.forename: Mahmoud El-Sayed
authors.initials: MS
authors.lastname: Ali
mesh_terms: D000368:Aged; D002425:Cautery; D015331:Cohort Studies; D006801:Humans; D007828:Laryngoscopy / Q000379:methods*; D007831:Larynx, Artificial; D008297:Male; D008866:Microsurgery / Q000379:methods*; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome