Surgical management of acquired nonmalignant tracheoesophageal and bronchoesophageal fistulae.
BACKGROUND
Acquired nonmalignant fistulae between the airway and esophagus (tracheoesophageal fistulae [TEF]) are rare life-threatening conditions. Several management approaches have been proposed, while the optimal strategy remains controversial.


METHODS
This study is a retrospective review of all patients with TEF treated at our institution from 1978 through 2007.


RESULTS
Thirty-five patients (22 men, 13 women) underwent surgical repair of acquired nonmalignant TEF. Median age was 55 years (range, 5 to 78). Most common causes were the following: complications of esophageal surgery (11), trauma (6), granulomatous infection (5), stent erosion (4), and prolonged mechanical ventilation (2). Location was proximal trachea in 7, mid-trachea in 5, and distal trachea or bronchus in 23. Fifty-six operations were performed. Six patients had staged repair, with 1 patient requiring 4 operations for recurrent TEF. TEF division and primary repair was performed in 18 patients, esophageal resection with reconstruction in 4, and esophageal diversion in 6. Four patients had suture closure of the esophageal or tracheal defect only, and 3 required segmental tracheal or bronchial resection. Four patients were ventilator dependent at the time of repair. Pedicled tissue flaps were used in 28 patients (80%). Operative mortality was 5.7% (2 of 35). Nineteen patients (54.3%) had complications. Median hospital stay was 14 days (range, 4 to 209). Median follow-up was 30.4 months (range, 0.5 to 233) and complete in 34 (97.1%). Three patients (8.6%) developed recurrent TEF. Twenty-nine patients resumed oral intake. One patient required a permanent tracheal T tube.


CONCLUSIONS
Single-stage primary repair of both airway and esophageal defects with tissue flap interposition can safely be performed successfully in the majority of patients with acquired nonmalignant TEF.
Shen
K Robert
KR
Division of General Thoracic Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA. shen.krobert@mayo.edu
Allen
Mark S
MS
Cassivi
Stephen D
SD
Nichols
Francis C
FC
Wigle
Dennis A
DA
Harmsen
W Scott
WS
Deschamps
Claude
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000209:etiology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery*; D055815:Young Adult