Congenital lesions such as H-type fistulas and congenital stenosis can be recognized in children and adults and treated surgically. Acquired tracheoesophageal fistulas from prolonged intubation can be repaired primarily after weaning from the respirator. Damage to the esophagus from corrosive substances can be graded and therapy guided by gross appearance. Damage from concentrated hydrochloric acid ingestion may require immediate surgery, even before endoscopic appraisal.