Endoscopic treatment of tracheoesophageal fistula using electrocautery andthe Nd : YAG laser

Background: Endoscopy is a well-established means of diagnosis in recurrent and congenital H-type tracheoesophageal fistulas. There is only limited kn owledge of its role in the treatment using either electrocautery or laser. Laser application has not yet been reported in the treatment of recurrent t racheoesophageal fistula. Methods: From 1993 to 1997 five patients with tracheoesophageal fistula (tw o congenital H-type and three recurrent) were treated endoscopically using a rigid ventilating bronchoscope. The final diagnosis was made on bronchosc opic examination. In two of the patients with recurrent fistulas and one wi th congenital fistula, the mucosal lining was fulgurated with electrocauter y via an insulated wire. In one patient each with recurrent and congenital fistula, the mucosal lining was vaporized with the Nd:YAG laser via a 600 p m bare quartz fiber. Results: Obliteration of the fistula was achieved in both the patients in w hom laser was used, but it was unsuccessful in two of the three children in whom electrocautery was used. The obliquity of the congenital H-type fistu la renders it more amenable to obliteration compared with the short and dir ect recurrent fistula. There was significant respiratory distress in the po stoperative period after use of electrocautery. However, it was uneventful with the use of laser. Conclusions Endoscopic treatment of recurrent and congenital H-type tracheo esophageal fistula is technically easier than open surgical procedures and helps avoid the risks associated with the latter. The Nd:YAG laser is quali tatively better than electrocautery for the obliteration of the fistula.