Benign Tracheal Esophageal Fistula

Abstract

Benign acquired tracheoesophageal fistula (TEF) is a rare complication related to prolonged mechanical ventilation, esophageal and mediastinal surgeries, chest trauma, or infection. TEF should be suspected in ventilated patients with persistent air leak, recurrent pneumonias, or those with persistent cough immediately following swallowing (Ono sign). Once identified, the only definitive solution for TEF is surgical correction. In preparation for surgical repair, most opt to wean patients from the ventilator and place a percutaneous gastrostomy tube for diversion. Surgical management of TEF varies based on size, location, and etiology. This article describes step-by-step repair of cervical and cervicothoracic TEFs via low anterior cervical collar approach. This technique offers greater exposure and has lower risk of devascularization and recurrent laryngeal nerve injury. Success rates approach 95%, with postintubation injury and TEF recurrence being the most common complications.