Acquired Tracheoesophageal Fistula: Annals of Surgery | August 2026

Introduction:

Acquired nonmalignant tracheoesophageal fistula (ANM-TEF) is a rare but potentially life-threatening condition requiring complex surgical management. Historically, prolonged intubation was the dominant cause. This 40-year surgical experience examined how etiology, reconstructive techniques, and outcomes have evolved.

Why was this study needed?

ANM-TEF is uncommon, and standardized management remains difficult.

Modern airway and esophageal interventions have changed its underlying causes.

Previous surgery or radiotherapy can leave severely damaged, poorly vascularized tissues.

Understanding these changes is essential for selecting appropriate reconstructive strategies.

Results:

Among 90 surgically treated patients, prolonged intubation declined dramatically as the dominant cause.

In the contemporary era, laryngeal cancer treatment and esophageal procedures became the major causes of ANM-TEF.

Because modern fistulas frequently involve compromised tissue vascularity, fasciocutaneous flap reconstruction became necessary in approximately two-thirds of recent cases.

Despite increasing anatomical complexity, initial fistula closure remained successful in 87%, although recurrent fistula and recurrent laryngeal nerve palsy remained important complications.

Clinical Impact:

Modern ANM-TEF is increasingly an iatrogenic reconstructive problem rather than an intubation-related injury. Management should therefore be concentrated in experienced multidisciplinary centers combining airway, esophageal, and reconstructive surgical expertise. Well-vascularized tissue interposition is increasingly important when previous surgery or cancer treatment has compromised local tissues.

Bottom Line:

The biology of acquired nonmalignant tracheoesophageal fistula has changed: prolonged intubation is being replaced by complications of laryngeal and esophageal interventions. Despite more severe tissue injury, modern flap-based reconstruction can maintain high rates of successful fistula closure.