Benign tracheo-neo-esophageal fistulas after subtotal esophagectomy

Background. Benign tracheo-neo-esophageal fistulas after esophagectomy are rare and treatment can be challenging. They can result from perioperative t racheal injury or various postoperative complications. Methods. Charts of 6 patients with a benign tracheoneo-esophageal fistula a fter subtotal esophagectomy treated in this institution between July 1993 a nd August 1999 were analyzed. Results. Three men and 3 women (median age 61 years) developed a fistula af ter subtotal esophagectomy. Symptoms varied from mild swallowing difficulti es to aspiration pneumonia and mediastinitis. Two patients with mild sympto ms were treated conservatively. In 1 patient a long fistula was partly exci sed through the neck. In 3 patients the gastric tube was excluded or excise d, with surgical closure of the tracheal defect. The alimentary tract was r econstructed by colonic interposition. There were no major complications. A fter a median follow-up of 1.6 years, all fistulas were closed. All patient s were capable of sufficient oral intake. Conclusions. A benign tracheo-neo-esophageal fistula after esophagectomy is a rare, but serious complication. Site and size of the fistula, together w ith the severity of symptoms, should dictate management. (C) 2001 by The So ciety of Thoracic Surgeons.