Tracheo-oesophageal fistula caused by cuffed tracheal tubes.

Two patients with tracheo-oesophageal fistula following endotracheal intubation and tracheostomy are reported. In both cases the fistulas were related to inflammation of the cuffs distal to the tracheostomy. Two kinds of surgical treatment were performed: (1) Resection of 3 cm of the cervical trachea, closure of the oesophageal fistula opening with absorbable sutures and interposing a muscle flap of the left sternohyoid muscle. (2) No resection of the trachea. Direct closure of the fistula openings, and interposition with fixation to the trachea of a vascularized intercostal muscle flap via a right-sided thoracotomy. For optimal results of surgery, the pre-operative requirements should include control of septicaemia and gastrobronchial regurgitation, establishment of spontaneous ventilation and correction of malnutrition. For these purposes, the gastrostomy and transgastric jejunostomy regime was important in our patients. The simultaneous use of tracheal and oesophagus tubes is considered a risk factor in development of tracheobronchial fistulas.