Use of Intercostal Flap for Conservative Surgical Management of Complex Lower Esophageal Fistula

Abstract

Lower esophageal fistula is a rare complication after upper digestive tract surgery, but it is associated with high morbi-mortality. There is no consensus on therapeutic care, however when reoperation is necessary, a pedicled intercostal flap from the thoracotomy can be easily harvested to patch a large defect or buttress a direct suture, saving digestive reconstruction. This technique should be mastered by thoracic and general surgeons.We present here two cases of lower esophagus fistulas cured thanks to this intercostal flap, in which we avoided fistula recurrence with maintenance of digestive continuity.