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

From 1962 to 1987, 27 patients with tracheo-oesophageal fistulae (TOF) were treated at our institution. Mean age was 43 years. The indications for respiratory support were blunt chest trauma (11), neurological dysfunction (8), and acute pulmonary distress syndrome (8). TOF symptoms occurred 12-200 days (mean 43) after initiation of ventilatory support and was caused by tracheostomy tube cuff (17), intubation tube cuff (8), or injury at the site of tracheostomy (2). The size of the fistula ranged from 0.3 to 5 cm (mean 2 cm). Seventeen of the 27 patients were operated upon. A simple repair of the TOF was performed via a cervical approach in 10 patients; tracheal resection and reconstruction was done in 4 patients presenting with tracheal stenosis, while 2 patients with slight tracheal stenosis had a simple repair of the TOF without the need for further tracheal surgery. Three patients underwent primary oesophagostomy, followed later by colon interposition. Five patients died. Ten cases were not operated upon: the TOF closed spontaneously in 1 patient, 1 patient was lost to follow-up and 8 died. In our series, significant tracheal stenosis occurred in only 6 patients (22%), only 4 of whom had tracheal resection. Simple repair of TOF provides excellent results with a low mortality (10%) considering the poor condition of the patients, and should be considered the procedure of choice. Surgical oesophageal diversion (i.e. cervical oesophagostomy and suture of distal oesophagus) is usually unnecessary.