Invited Commentary

Abstract

The management of patients with nonmalignant tracheoesophageal fistula is a surgical challenge because they are not suitable for expedient short-term procedures such as the use of expandable stents or tissue glue but require careful dissection with repair of the trachea and esophagus and a buttress to minimize the likelihood of recurrence. If the repair breaks down, further surgical procedures in the area are fraught with difficulty, and many surgeons would abandon another attempt at direct repair and perform a bypass procedure using stomach or colon. The surgeons from St. George University Teaching Hospital in Budapest, Hungary, have reported a remarkable series of 8 patients treated during a 10-year period who had recurrent nonmalignant tracheoesophageal fistulae [1Altorjay Á. Mucs M. Rüll M. et al.Recurrent, nonmalignant tracheoesophageal fistulas and the need for surgical improvisation.Ann Thorac Surg. 2010; 89: 1789-1796Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar]. All of the patients were referred from elsewhere and had undergone between one and four prior attempts at repair. They were then managed in a multidisciplinary setting, and the procedure performed was tailored to each individual with the emphasis on preserving normal anatomy as far as possible. No patient required more than one operation, and there was no operative mortality and commendably low morbidity. Only one patient suffered from a unilateral long-term paresis of the vocal cord. These results highlight the value of referring this type of patient to a known center of excellence and the use of multidisciplinary clinics. Recurrent, Nonmalignant Tracheoesophageal Fistulas and the Need for Surgical ImprovisationThe Annals of Thoracic SurgeryVol. 89Issue 6PreviewDespite the many recent advances in thoracic surgery, the management of patients with recurrent, nonmalignant tracheoesophageal fistulas remains problematic, controversial, and challenging. Full-Text PDF