Tracheobronchial Fistula During the Perioperative Period of Esophagectomy for Esophageal Cancer

Abstract

Careful dissection with direct vision of the esophagus, as well as oversewing of the staplers on the gastric tube, is mandatory for preventing TB injury and fistula formation. Appropriate drainage is effective in cases with peri-tracheal abscesses. If the TB fistula fails to heal within a 4- to 6-week period, conservative management should be abandoned. Direct surgical intervention with coverage by a muscle flap is important for TB fistulas.

Diagnosis, assessment, and management of surgical complications following esophagectomy

“…Of the 17 patients, 13 were alive at the time of reporting. Various tissue flaps were described, including three latissimus dorsi flaps, five pectoralis major flaps, two sternocleidomastoid muscle flaps, one intercostal muscle flap, one sternohyoid muscle flap, one skin perforator pedicled by an intercostal muscle flap, five pericardial flaps, and one pleural flap . No clear evidence supports the superiority of any one operative approach.…”

Development of fistula between esophagogastric anastomotic site and cartilage portion of trachea after subtotal esophagectomy for cervical esophageal cancer: a case report

“…We decided to perform an operation. An omental or pleural patch or a muscle flap can be applied to fill the dead space and add vital tissue to the defect, preventing recurrent fistulization [ 18 , 19 ]. Because blood flow is poor in the area of the leakage, these vital soft tissues play an important role in wound healing and control of local infection.…”

Gastrobronchial fistula following minimally invasive esophagectomy for esophageal cancer in a patient with myotonic dystrophy: Case report

“…The optimal treatment for gastrobronchial and gastrotracheal fistulas after posterior route mediastinal esophagectomy and intrathoracic esophagogastric anastomosis is still controversial, because of variable results with a high incidence of serious morbidity and considerable mortality [9] , [10] . The mainstay of treatment is surgical in one or two stages depending on severity of the leakage, size of the fistula, blood supply of the conduit and the general health of the patient.…”

“…In the second stage the continuity of the gut is restored either with an anastomosis between esophagus and the initial but partially resected conduit or by colon or jejunum. Of the 44 patients reported with tracheobronchial fistula after surgery regardless of etiology [9] , [11] , 14 patients developed gastrobronchial fistula after esophagectomy for cancer and the mean mortality rate was 25% (range 0–100%). If conservative treatment can reduce this high mortality it should be attempted.…”