TRACHEOESOPHAGEAL FISTULAS

Tracheoesophageal fistula is an uncommon clinical problem, and can be either congenital or acquired in origin. In this report, we present ou r experience in the management of 41 patients with tracheoesophageal f istula (28 male, 13 female; age ranging from 8 to 69 years) who were s een during the period spanning 1968 to 1989 at the National Research C enter of Surgery, Moscow. During this time frame fewer malignant and c orrespondingly more posttraumatic and postoperative fistulas were obse rved. The most common clinical findings were cough associated with eat ing, production of sputum mixed with food, and weight loss with profou nd weakness. In the vast majority of patients, diagnosis was made usin g radiologic contrast studies, with endoscopic assessment being occasi onally necessary. We classify our surgical approaches as ''radical'' ( the isolation and ablation of the communication), ''conditionally radi cal'' (implying creation of a neoesophagus or thoracoplasty with muscl e flap obliteration of the fistula and associated chronic empyema cavi ty), or ''palliative'' (usually entailing gastrostomy alone). Of the 3 2 patients undergoing surgical treatment in this series, 21 underwent radical or conditionally radical procedures; there was no operative mo rtality, and long-term follow-up shows that 19 of the 20 long-term sur vivors report satisfactory, good, or excellent status. This report sum marizes the indications, timing, technique, and results of the various surgical approaches, and also delineates measures for the prevention of postoperative tracheoesophageal fistula.