Experience on the diagnosis and treatment of intrathoracic gastro-airway fistulae after esophagectomy for esophageal carcinoma / 中华胸心血管外科杂志

ABSTRACT

Objective To summarize our results and experience in dealing with the postoperative intrathoracic gastro-air-way fistulae after esophagectomy for esophageal carcinoma.Methods From January 2010 through February 2012,1490 patients with esophageal carcinoma underwent esophagectomy in our department.The postoperative intrathoracic gastro-airway fistulae were documented in 10 patients,with a frequency of 0.67％.Five of them died.The possible etiology,clinical characters,treatment and prevention of this complication were reviewed.Results The location of the fistulate were 7 at left main bronchus,1 at right main bronchus,and 2 at distal trachea.After 2-3 weeks conservative treatment,1 patient underwent primary surgical repair and cured,1 refused any further intervention and sacrified,8 patients underwent endoscopic insertion of covered stent and only 3 healed.For the remaining 5 cases with failed stent therapy,2 died of severe aspiration and lung infection,3 had surgical repair,one of them successed and 2 died of aspiration and aortic rupture,respecively.Conclusion The development of intrathoracic gastro-airway fistulae was associated with the iatrogenic injuries and suturing material irritation of the gastric tube to the tracheal/bronchial wall.Therefore,a meticulous closure and wapping of gastroplasty and appropriate isolation using artifical patch or great omentum between airway and esophageal substitution could effectively reduce the fistulae.The stent therapy usually fails in treating this entity and surgical repair remains the final and ratical therapeutic option.Primary repaire is suggested and careful preoperative assessment is crucial.