Surgical Management of Tracheoesophageal Fistula

This written and video case review from Osho and colleagues centers on a 54-year-old woman who suffered smoke inhalation injury as a result of a house fire. Following prolonged intubation, mechanical ventilation, open tracheostomy tube placement, and recurrent pneumonia, the patient was diagnosed with a tracheoesophageal fistula (TEF). The authors prefer to manage TEF via an anterior cervical approach with division of the trachea, though a right thoracotomy may be used in the setting of highly distal TEFs. They emphasize that careful operative technique and the interposition of a robust muscle flap are the most important safeguards in surgical management of TEF.