PS02.230: CLOSURE OF POSTESOPHAGECTOMY GASTROTRACHEAL FISTULA FOLLOWING MINIMALLY INVASIVE ESOPHAGECTOMY THROUGH THE STOMACH CONDUIT OPENING

Abstract

Abstract Background The prevalence gastro-tracheal fistula following esophagectomy is rare, however, very difficult to cure, and often results in fatal outcomes. We experienced surgical repair of gastro-tracheal fistula after minimally invasive esophagectomy, thereby reported here. Methods A 66 year-old male patient had undergone VATS esophagectomy combined with cervical esophagogastrostomy through posteromediastinal route for his esophageal cancer (pT2N2M0). After concurrent chemo-radiation therapy for local recurrence in subcarinal area, gastro-tracheal fistula was developed between the posterior membranous wall of trachea just above carina and gastric conduit. Surgical correction was performed through right posterolateral thoracotomy. After longitudinal incision on the gastric conduit near the location of gastro-esophageal fistula, the fistula tract was exposed, and closed using three layer sutures with vicryl 3–0. Results The patient stayed at intensive care unit for only one day. During the periods of nil per os, the nutrition had supported by intravenous administration and jejunostomy. After 2 weeks of nil per os, postoperative bronchoscopy and endoscopy was performed. No remnant fistula was noted on both examinations suggesting successful fistula closure. And, the patient was discharged without any complications on postoperative day 28. Conclusion Conduit-airway fistula could be caused by diverse risk factors such as thermal injury during the dissection, external beam irradiation, and severe malnutrition. Less invasive procedures including endoscopic interventions could be amenable, however, direct surgical repairs might be required for prompt closure of fistula and minimizing further complications. Disclosure All authors have declared no conflicts of interest.