OCCASIONALLY a troublesome fistula develops between the trachea and esophagus following total laryngectomy or reconstruction of the cervical esophagus.1 This occurs at the level of the tracheostoma or in the posterior wall of the upper trachea. A cuffed tracheal tube will control the salivary leak into the trachea prior to repair of the tracheo-esophageal fistula. The operation to be described has been used for the successful closure of three tracheo-esophageal fistulae, one following laryngectomy and two following reconstruction of the cervical esophagus. Two separate pedicled flaps are used in the procedure, one to supply esophageal lining and the other tracheal lining. The flaps are fashioned and positioned so as to lie back-to-back in the tracheo-esophageal fistula.
The operation is best performed using general anesthesia with intermittent use of an endotracheal tube, for it is quite difficult to block the very sensitive cough reflex of the trachea with local anesthesia.
MONTGOMERY WW. Tracheo-Esophageal Fistula: Surgical Repair. Arch Otolaryngol. 1965;82(5):543–545. doi:10.1001/archotol.1965.00760010545018
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