Transtracheal microsurgical closure of tracheoesophageal fistulas

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Abstract
A patient with a 1.5‐ to 2.5‐cm tracheoesophageal fistula secondary to prolonged assisted ventilation and feeding by a nasogastric tube was operated upon by a transtracheal microsurgical approach. The advantages of this approach are as follows: (1) the surgery is not extensive and therefore does not cause much stress to the patient: (2) this technique avoids the necessity for a wide mediastinotomy or sternotomy and thoracotomy and therefore averts the danger of a widespread infection with the highly antibioticresistant bacteria that are always present in these cases; and (3) there is no risk of damage to the recurrent nerve. The ENT surgeon who is welltrained and experienced in microsurgery should try this approach in selected cases first. If this method fails, other methods are still available.