Surgical management and treatment of esophageal fistula

Esophageal fistulas in adults may involve any of the adjacent structures. The common fistula acutely involves the mediastinum and pleura or the soft tissues of the neck. Prompt drainage is the mainstay of treatment; in the chest, temporary esophageal diversion with delayed reconstruction is usually the most conservative approach. Chronic fistulas are caused most often by cancer, and palliation is the usual therapeutic goal. Repair by operation is occasionally indicated and sometimes successful, particularly in patients with lymphomas. Occasionally fistulas are congenital or acquired, and these fistulas rarely involve the great vessels. Successful repair is the aim of treatment. The choice of therapy for esophageal fistulas requires exquisite judgment, prompt aggressive intervention, and a good surgical technique.