Editing Trache-oesophageal fistula (section)

== Treatment ==

=== Benign TOF are primarily managed with surgery ===
*** Anterior collar incision. May require sternotomy for access to distal trachea.
*** Single-stage is preferable when possible
*** Two-stage repair (tracheal resection and reconstruction with oesophageal diversion via cervical oesophagostomy, followed by interval primary oesophageal reconstruction)

=== Malignant TOF  are palliative ===
*** Surgery is not worthwhile in almost all cases - prognosis of weeks to months
*** Palliative stenting is effective for symptomatic fistulae
**** Individual or combination of stents placed across the fistula, to prevent passage of enteric contents
***** Barium swallow will be necessary in identifying anatomy
***** Optimise patient as much as possible, as for benign fistulae
***** Most malignant TOFs can be sealed using self-expanding metal or plastic covered or partially covered oesophageal stent
***** In some cases, tracheal stents may also be needed
***** Stents not recommended for stents at or above cricopharyngeus, because this will result in significant discomfort and dysphagia. In such cases, a definitive tracheostomy may be placed.
***** Fistulae to lobar or segmental bronchi are difficult to seal via bronchial stenting, so would be normally treated with oesophageal stent alone
***** Need minimal IV sedation and topical or nebulised anaesthetic
[[Category:UGIS]]
[[Category:Thoracics]]