MANAGEMENT OF MALIGNANT TRACHEOESOPHAGEAL FISTULAS WITH A CUFFED FUNNEL TUBE

Background. A detachable cuffed flange tube for the assessment of mali gnant tracheoesophageal fistulas by a minimal invasive surgical insert ion technique is presented. The funnel cuff of this tube seals the spa ce between the esophageal wall and the flange of conventional tubes ab ove the fistula at the level of the suprastrictural dilatation. Method s. Twenty-eight patients having a malignant esophagorespiratory fistul a with associated primary or secondary esophageal stricture, except 1, underwent esophageal intubation with this prosthesis between 1983 and 1996. Results. All insertion attempts, without previous esophageal di lation, were successful. The overall mortality was 7.4%. The cuffed fu nnel has provided hermetic watertight exclusion of the fistula in all instances. Intraabdominal septic complications, reflux, or tube displa cement have never occurred after use of this intubation technique. Con clusions. For occlusion of malignant respiratory tract fistulas this c uffed flange tube proved to be superior to conventional esophageal pro stheses. (C) 1997 by The Society of Thoracic Surgeons.