Giant tracheoesophageal fistula: management by esophageal diversion

Giant tracheoesophageal fistulas complicating the management of respiratory insufficiency are often difficult to close successfully because of suture line tension and narrowing of the trachea or esophagus or both. Recovery of lung function often depends on successful diversion of gastrointestinal contents from the tracheobrachial tree. We have managed six patients with giant tracheoesophageal fistula. In three cases the lesions were related to overinflation of low-pressure balloon cuffs. The only survivors were two of three patients managed by esophageal diversion and reconstruction through extrathoracic incisions. The techniques, advantages, and disadvantages of esophageal diversion for giant tracheoesophageal fistula are presented.