Surgical repair of mechanical ventilation induced tracheoesophageal fistula

  • Muthuswamy DhiwakarEmail author
  • Ohad Ronen
  • Mrinal Supriya
  • Shivprakash Mehta
Review Article



To evaluate the outcomes of surgery to repair tracheoesophageal fistula (TEF) caused by mechanical ventilation.


Case series and review of all cases reported in English literature. Only reports of TEF following mechanical ventilation and containing description of surgical repair and outcomes were included.


A total of 41 studies comprising 143 patients met the inclusion criteria. Most studies had incomplete information on important variables such as co-morbidity and fistula size. Tracheal resection anastomosis (TRA) was the most common approach, performed in 91 (63.6%) patients (including three newly reported here). Lateral approach repair (LA) was done in 45 (31.5%) patients. The former had a higher incidence of pre-existing tracheal stenosis [53 (89.8%) vs. 7 (35%) cases; p < 0.001]. Flap interposition to augment the repair was done in 49 (53.9%) and 40 (88.9%) cases, respectively (p < 0.001). Successful and durable healing of the fistula were achieved in 90 (98.9%) cases in TRA and 39 (88.6%) cases in LA.


In carefully selected cases of TEF caused by mechanical ventilation, TRA is the most preferred approach, delivering successful healing in almost all cases. Where TRA is not indicated or preferred, LA appears to be a good alternative. Future studies should explicitly report all of the known co-variables, so that the exact indications for choosing a particular surgical approach could be better elucidated.


Trachea Esophagus Fistula Ventilation Surgery 



All authors declare that there is no conflict of interest and there is no financial, personal or other relationship that might influence this work. There is no internal or external source of funding obtained for this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Muthuswamy Dhiwakar
    • 1
    Email author
  • Ohad Ronen
    • 2
  • Mrinal Supriya
    • 3
  • Shivprakash Mehta
    • 1
  1. 1.Departments of Otolaryngology-Head and Neck SurgeryKovai Medical Center and HospitalCoimbatoreIndia
  2. 2.Galilee Medical CenterBar-Ilan UniversitySafedIsrael
  3. 3.Milton Keynes University HospitalMilton KeynesUK

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