Tracheo-oesophageal fistula and pre-operative mechanical ventilation.

Twelve patients with tracheo-oesophageal fistula (TOF) and restrictive lung disease necessitating pre-operative ventilation are reported. Eight patients had respiratory distress syndrome, four had aspiration pneumonia, and 11 had associated oesophageal atresia. Two patients in whom a preliminary gastrostomy was performed died. Emergency ligation of the fistula was performed in 10 patients, nine of whom survived. Following division of the fistula, respiratory function improved dramatically in three patients and primary oesophageal repair was performed. Three patients underwent delayed primary repair and the oesophagus was sacrificed, with a view to replacement at a later date, in the remaining three patients. We believe that the presence of a TOF in a neonate with poorly compliant lungs requiring mechanical ventilation represents a serious surgical challenge. Gastrostomy alone should never be performed. Ligation of the fistula with either immediate or delayed primary repair of the oesophagus are the treatments of choice.