Definitive preoperative diagnosis of H-type TEF is important and, once this is made, localization of the level of the fistula becomes a priority for the proper choice of operative approach.

This can be ascertained from the contrast study or via a preoperative bronchoscopy.

To treat H-type TEF, a variety of techniques have been used including:

The treatment of H-type TEF is traditionally through an open approach via a cervical or thoracic incision.

Although a low H-type TEF should be repaired by a transthoracic approach, the majority of cases, however, can be repaired via a transcervical approach which is less invasive than a thoracotomy and has a low morbidity and mortality.

Add to this the fact that the transthoracic approach may not be an adequate approach for all the cases.