Management of malignant tracheoesophageal fistulas with a cuffed funnel tube.

Abstract

A detachable cuffed flange tube for the assessment of malignant tracheoesophageal fistulas by a minimal invasive surgical insertion technique is presented. The funnel cuff of this tube seals the space between the esophageal wall and the flange of conventional tubes above the fistula at the level of the suprastrictural dilatation. Twenty-eight patients having a malignant esophagorespiratory fistula with associated primary or secondary esophageal stricture, except 1, underwent esophageal intubation with this prosthesis between 1983 and 1996. All insertion attempts, without previous esophageal dilation, were successful. The overall mortality was 7.4%. The cuffed funnel has provided hermetic water-tight exclusion of the fistula in all instances. Intraabdominal septic complications, reflux, or tube displacement have never occurred after use of this intubation technique. For occlusion of malignant respiratory tract fistulas this cuffed flange tube proved to be superior to conventional esophageal prostheses.