Acquired nonmalignant tracheoesophageal fistula.

Acquired tracheoesophageal fistula (TEF) caused by cuffed tracheal tubes, surgical trauma, and blunt injuries is an unusual and serious problem. Several differing approaches to management have been proposed. We have repaired such fistulas in 20 patients; 14 of them were related to tracheal intubation, three to blunt trauma, two followed anterior cervical spine fusions, and one resulted from a foreign body. Fistula closure on ventilator-dependent patients was usually delayed until they were weaned from respiratory support. Four patients had esophageal diversion before repair of their fistulas. There was sufficient tracheal damage to require resection and end-to-end anastomosis in 13 patients. The esophageal defect was closed directly in 16 patients, and end-to-end reconstruction of the esophagus was accomplished in four. There were two deaths, and one fistula recurrence required reoperation. These results support our recommendations to delay fistula closure in most ventilator patients, to use esophageal diversion selectively, to employ tracheal resection when there is evidence of extensive damage, and to directly repair the esophagus.