Surgical management of acquired post-intubation tracheo-oesophageal fistulas: 27 patients

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Abstract
From 1962 to 1987, 27 patients with tracheo-oesophageal fistulae (TOF)were treated at our institution. Mean age was 43 years. The indications forrespiratory support were blunt chest trauma (11), neurological dysfunction(8), and acute pulmonary distress syndrome (8). TOF symptoms occurred12-200 days (mean 43) after initiation of ventilatory support and wascaused by tracheostomy tube cuff (17), intubation tube cuff (8), or injuryat the site of tracheostomy (2). The size of the fistula ranged from 0.3 to5 cm (mean 2 cm). Seventeen of the 27 patients were operated upon. A simplerepair of the TOF was performed via a cervical approach in 10 patients;tracheal resection and reconstruction was done in 4 patients presentingwith tracheal stenosis, while 2 patients with slight tracheal stenosis hada simple repair of the TOF without the need for further tracheal surgery.Three patients underwent primary oesophagostomy, followed later by coloninterposition. Five patients died. Ten cases were not operated upon: theTOF closed spontaneously in 1 patient, 1 patient was lost to follow- up and8 died. In our series, significant tracheal stenosis occurred in only 6patients (22%), only 4 of whom had tracheal resection. Simple repair of TOFprovides excellent results with a low mortality (10%) considering the poorcondition of the patients, and should be considered the procedure ofchoice. Surgical oesophageal diversion (i.e. cervical oesophagostomy andsuture of distal oesophagus) is usually unnecessary.

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