Giant acquired tracheoesophageal fistulas: Strategy for successful management

✍ Scribed by Freeman, M. Sean ;Livingstone, Alan S. ;Goodwin, E. Jarrard

• Publisher: Wiley (John Wiley & Sons)
• Year: 1986
• Weight: 288 KB
• Volume: 8
• Category: Article
• ISSN: 0148-6403
• DOI: 10.1002/hed.2890080611

✦ Synopsis

Giant tracheoesophageal fistulas (TEF) present a significant management problem for the head and neck surgeon. Chronic aspiration and sepsis are associated complications that occur in these patients, who are frequently already debilitated from preexisting medical calamities. The combination results in prolonged morbidity and frequent mortality. Recently, we have managed two patients with this difficult problem. The first patient was managed using conventional methods well described in the literature with an unsuccessful outcome. The second was managed differently using a two-stage approach. The esophageal stream was first excluded from the respiratory system via a surgical approach, which to the best of our knowledge has not been previously described in the literature. After a period of convalescence, the patient's alimentary tract is reconstituted with a gastric pull-up, reversed gastric tube, or colon interposition. We propose this as an alternative method of management for TEF. HEAD & NECK SURGERY 8:463-465,1986 Giant tracheoesophageal fistulas (TEF) are most often iatrogenic in origin and occur in patients who are already critically ill. Consequent aspiration compounds pre-existing pulmonary problems and nutrition is often poor. In such a setting, From the Departments of Otolaryngology (Drs. Freeman and Goodwin)