Surgery for non-neoplastic tracheal fistula in patients with artificial esophagus after esophagoplasty

OBJECTIVE: To improve treatment outcomes in patients with fistula between the trachea and artificial esophagus. MATERIAL AND METHODS: Between 2004 and 2023, 115 patients with non-neoplastic tracheoesophageal fistulas were treated. Among them, 5 patients (4.3%) developed fistulas between the trachea and neo-esophagus in 1.5-16 years after esophagectomy for cancer. Surgical strategies included extirpation of neo-esophagus with delayed re-esophagoplasty, fistula separation combined with tracheoplasty or T-tube placement, and simultaneous colo-esophagoplasty following removal of gastric conduit. RESULTS: There were no perioperative deaths. Postoperative recovery was uneventful in all cases with successful separation of respiratory and gastrointestinal tracts. In patients with concomitant cicatricial stenosis, tracheal patency and safe respiration were restored. CONCLUSION: In long term after extirpation of the esophagus for cancer and esophagoplasty, fistulas between the trachea and neo-esophagus are possible. Concomitant cicatricial tracheal stenosis in 50% of patients worsens their status and complicates surgical treatment. This is the most complex and severe group of patients. Etiopathogenesis of fistula between trachea and artificial esophagus in long-term period is unclear and requires further study. Considering high probability of concomitant cicatricial tracheal stenosis, we can assume that chronic inflammatory process in trachea and artificial esophagus is important. Available basic principles for diagnosis and repair of tracheal anastomosis with native esophagus allow them to be used in fistulas with neo-esophagus with good results. Concomitant stenotic transformation of trachea and esophagus requires reconstruction, including autograft extirpation with re-esophagoplasty, as well as tracheal resections.