Transtracheal microsurgical closure of tracheoesophageal fistulas

A patient with a 1.5- to 2.5-cm tracheoesophageal fistula secondary to prolonged assisted ventilation and feeding by a nasogastric tube was operated upon by a transtracheal microsurgical approach. The advantages of this approach are as follows: (1) the surgery is not extensive and therefore does not cause much stress to the patient; (2) this technique avoids the necessity for a wide mediastinotomy or sternotomy and thoracotomy, and therefore averts the danger of a widespread infection with the highly antibiotic-resistant bacteria that are always present in these cases; and (3) there is no risk of damage to the recurrent nerve. The ENT surgeon who is well-trained and experienced in microsurgery should try this approach in selected cases first. If this method fails, other methods are still available.