Surgery for Benign Tracheoesophageal Fistula: Analysis of Short- and Long-Term Outcomes

Background: Adult, benign tracheoesophageal fistula is a life-threatening condition. The aim of this study is to report our experience with its surgical treatment, including short- and long-term outcomes. Methods: We conducted a retrospective, single-center review of patients who underwent surgical repair of tracheoesophageal fistula at a single center from 1997 to 2023. We compared clinical characteristics and outcomes between patients operated on by different surgical techniques. Furthermore, we analyzed long-term outcomes including survival, decannulation rate, and resumption of oral intake. Results: Overall, 60 patients underwent fistula repair during the study period. The main etiology was post-intubation injury (78.3%). The airway defect was repaired by direct suture, airway resection-anastomosis or flap/patch interposition in 8 (13.3%), 30 (50.0%) and 22 (36.7%) cases, respectively. The esophageal defect was repaired by double-layered suture in 56 (93.3%) cases and esophageal diversion in 4 (6.7%). Morbidity was observed in 32 patients (53.3%), including fistula relapse in 2 cases. In-hospital mortality occurred in two patients (3.3%). The overall survival, the cumulative incidence of decannulation, and of resumption of oral feeding at 5 years were 70.5%, 68.4%, and 86.6%, respectively. Conclusions: Surgical correction of tracheoesophageal fistula is challenging and requires an individualized approach. Healing of the fistula can be achieved in the majority of cases, including patients with extensive defects or under mechanical ventilation. Long-term outcomes are less satisfactory, and seem to be determined mainly by patients' comorbidities.