Simplified access for division of the low cervical/high thoracic H-type tracheoesophageal fistula

H-type tracheoesophageal fistulas (H-TEF) often are located in the low cerv ical/high thoracic region where determination of the most appropriate surgi cal approach is difficult. When it can provide adequate exposure, a cervica l incision is preferred because of the likelihood of decreased morbidity, A child with VACTERL association presented with recurrent respiratory proble ms. Esophagogram showed an H-TEF below the level of the clavicle, A vascula r guide wire was placed through the H-TEF with the ends brought out through the mouth. Under fluoroscopic guidance, gentle traction was placed on the wire to bring the fistula into the neck for an easily accessible cervical e xposure, thus eliminating the need for a thoracotomy. Copyright (C) 2000 by W.B, Saunders Company.