DEFINITIVE LOCALIZATION OF ISOLATED TRACHEOESOPHAGEAL FISTULA USING BRONCHOSCOPY AND ESOPHAGOSCOPY FOR GUIDE-WIRE PLACEMENT

Purpose: To aid in identification of isolated tracheoesophageal fistul as (TEF), many surgeons have recommended the bronchoscopic placement o f a ureteric or Fogarty catheter. This method can fail because of intr aoperative dislodgment of the catheter. The authors present a new tech nique that enables us to definitively isolate and treat all H-type fis tulas. Methods: Six cases of isolated TEF are presented consisting of 4 H-type fistulas, a proximal pouch fistula, and a recurrent TEF. Thre e of the patients had undergone a total of four prior failed operation s at outside institutions using attempted bronchoscopic catheter place ment. On all six patients, bronchoscopy was first performed where the fistula tract was noted in the trachea and a guide wire was passed thr ough the fistula. After orotracheal intubation, the authors performed rigid esophagoscopy; the guide wire was identified and brought out thr ough the mouth. This created a wire loop through the fistula. With the use of x-ray we were then able to visualize the level of the fistula and determine whether a cervical or thoracic approach should be used. Identification of the fistula intraoperatively was then facilitated by traction on the loop by the anesthesiologist. Results: Five of the si x TEFs were repaired with neck exploration; one required right thoraco tomy. In all patients, the fistula was identified and divided. There w ere fro recurrences or other complications. Conclusion: This new techn ique is a simple and definitive method in identification and treatment of isolated TEF. Copyright (C) 1998 by W.B. Saunders Company.