title: Surgical treatment of nonmalignant tracheoesophageal fistula: a thirty-five year experience.
abstract: BACKGROUND
  Acquired nonmalignant tracheoesophageal fistula in the adult patient develops in a variety of conditions. We have applied surgical closure with success for 35 years.
  
  
  METHODS
  From 1975 to 1991, 38 patients underwent surgical repair of a tracheoesophageal fistula. A retrospective study of 36 additional patients undergoing surgical repair from 1992 to 2010 was conducted.
  
  
  RESULTS
  The most common causes were postintubation injury (n=17, 47%), trauma (n=6, 17%), prior laryngectomy (n=6, 17%), and prior esophagectomy (n=4, 11%). Four patients presented after failing fistula control with an endoluminal stent. The tracheal defect was closed with resection and reconstruction (n=17, 41%), laryngotracheal resection (n=5, 12%), membranous tracheal repair (n=17, 41%), or repair over a tracheal T tube (n=2, 5%), while esophageal repair consisted of 2-layer closure (n=31, 78%), 1-layer closure (n=6, 15%), esophagostomy (n=1, 3%), end-to-end esophageal anastomosis (n=1, 3%), or full thickness skin graft reconstruction (n=1, 3%). The esophageal and tracheal repairs were buttressed by interposing pedicled muscle or omental flaps in all patients. There was 1 postoperative death (3%). Recurrence after repair developed only in fistulas arising after esophagectomy or laryngectomy (n=4, 11%). Fistula closure was ultimately successful in 34 patients (94%). Twenty-nine patients (83%) resumed oral intake and 25 patients (71%) were breathing without a tracheal appliance.
  
  
  CONCLUSIONS
  Successful closure of benign tracheoesophageal fistula is achieved with several surgical techniques based on buttressed repair and restoration of normal breathing and swallowing. Closure of complex postsurgical fistula may fail. Endoluminal stenting was not found useful.
authors.affiliation: Division of Thoracic Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. amuniappan@partners.org
authors.forename: Ashok
authors.initials: A
authors.lastname: Muniappan
authors.forename: John C
authors.initials: JC
authors.lastname: Wain
authors.forename: Cameron D
authors.initials: CD
authors.lastname: Wright
authors.forename: Dean M
authors.initials: DM
authors.lastname: Donahue
authors.forename: Henning
authors.initials: H
authors.lastname: Gaissert
authors.forename: Michael
authors.initials: M
authors.lastname: Lanuti
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Mathisen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D002648:Child; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D014132:Trachea / Q000601:surgery*; D014138:Tracheoesophageal Fistula / Q000209:etiology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult