Microscopic transtracheal repair of migrating tracheoesophageal fistula.

Objective: The repair of a persistently leaking migrating tracheoesophageal fistula (TEF) represents a particular challenge owing to the low site of the fistula down to the tracheoesophageal septum (TES). A simple microscopic approach to repair a migrating TEF is described.
Design: A description of five cases of migrating TEF. The repair technique and surgical outcome are described in detail.
Setting: Tertiary care referral hospital.
Methods: Excision of the fistula tract was done under local anesthesia and microscopic vision using microlaryngoscopic instruments followed by one-layer repair without soft tissue interposition. This technique was used in one patient with a leaking migrating TEF when planned dissection through the TES was abandoned. Subsequently, the technique was employed in four other patients with a similar TEF.
Main Outcome Measures: Evidence of complete closure of the fistula was assessed clinically 1 week postoperatively. This was followed by methylene blue and Gastrografin swallowing tests. The methylene blue test was repeated after 6 months to exclude recurrence of the fistula and confirm persistent closure.
Result: Complete closure of the fistulae was achieved when assessed clinically and by methylene blue and Gastrografin tests. All patients were discharged on a normal diet. Stable closure was confirmed by the methylene blue test after 6 months. The microlaryngoscopic instruments and surgical microscope have greatly facilitated access and dissection of the migrating fistula with minimum soft tissue loss.
Conclusion: The described technique is simple, relatively safe, and reproducible for closure of a small migrating TEF. It can also be used to repair small, nonmigrating TEF.