Management and outcomes of acquired benign tracheoesophageal fistula: a single-centre experience of 58 cases.

Background: Acquired benign tracheoesophageal fistula (TEF) is a complex and life-threatening condition that can coexist with tracheal stenosis. Surgical intervention is required in most cases of TEF, and many possible approaches have been described. Given the rarity of this condition and the reported high morbidity of treatment, we sought to identify possible risk factors and present the results of our preferred surgical method. Methods: We retrospectively identified patients with TEF who were surgically treated at the National Research Institute of Chest Diseases. Patients with congenital and malignant fistulas were excluded. Perioperative characteristics, complications, and surgical outcomes were recorded. Multivariate analysis of risk factors was performed. Results: Fifty-eight patients were surgically treated between 1998 and 2023, the majority of whom had postintubation TEF. The surgical approach included cervicotomy in 76%, cervicotomy with partial sternotomy in 14%, and sternotomy in 2% of the cases. The morbidity rate was 21%, and the most common complications were vocal cord palsy (14%), anastomosis dehiscence (7%) and fistula recurrence (7%). Multivariate analysis revealed that a length of resection >3 cm was an independent risk factor for this complication and poor short-term outcome (P=0.004). Postoperative placement of a T-tube was needed in 7% of patients, and reoperation was needed in 7% of patients. Conclusions: Surgical treatment of TEF is an effective method for providing definitive treatment in the majority of cases. Extremely meticulous preparation of the patient before the planned surgery is highly difficult. The length of the resected tracheal segment is an independent prognostic factor for severe postoperative complications, including fistula recurrence.