What are the treatment options for tracheoesophageal fistula (TEF)?

Updated: Nov 07, 2018
  • Author: Sat Sharma, MD, FRCPC; Chief Editor: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS  more...
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Answer

Surgical repair is required following confirmation of a diagnosis of tracheoesophageal fistula (TEF). Note the following:

  • In healthy infants without pulmonary complications, primary repair is performed within the first few days of life. Repair is delayed in patients with low birth weight, pneumonia, or other major anomalies. Initially, treat patients conservatively with parenteral nutrition, gastrostomy, and upper pouch suction until they are considered to be low risk.

  • Preoperatively, a cuffed endotracheal tube is placed distal to the fistula site in order to prevent reflux of gastric contents into the lungs. The ongoing mechanical ventilation following tracheal reconstruction is associated with recurrence of TEFs or restenosis. A conservative approach is therefore used until the patient is weaned from the mechanical ventilator. A tracheostomy tube is placed distally to the TEF if possible. The head of the bed is elevated, and oral secretions are frequently suctioned. A gastrostomy tube is placed to minimize gastroesophageal reflux, and a jejunostomy feeding tube is placed for nutritional purposes. If soilage of the respiratory tract continues, esophageal diversion procedures may be required.

  • Because acquired TEFs do not close spontaneously, surgical repair is planned if the patient is stable enough. Critically ill patients are managed conservatively until stable enough for a major surgical procedure.


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