Residual tracheal pouch after repair of tracheaoesophageal fistula: endoscopic KTP laser treatment

There is usually a small pouch within the trachea after ligation and division of a tracheoesophageal fistula. Most are asymptomatic, but some present with cough or by causing problems with endotracheal or tracheostomy tubes. Repeated open transthoracic surgery to ligate the fistula closer to the tracheal wall is problematic because the pouch is within the wall itself. We have found that bronchoscopic treatment with the potassium (K) Titanyl Phosphate laser to divide the party wall provides a quick and effective way to deal with the pouch, and we present a series of four cases to illustrate this technique.