Gastrotracheal Fistula as a Result of Transhiatal Esophagectomy for Esophageal Cancer: An Unusual Complication

Abstract

Gastrotracheal fistula following open transhiatal esophagectomy (Orringer's technique) for esophageal cancer is an unusual but lethal complication. Surgical intervention with resection of the fistula tract and primary interrupted suturing of gastric and tracheal orifices using a muscle flap interposition has proved to be a successful method. We report the case of a 73-year-old male with an adenocarcinoma of the distal part of the esophagus, who underwent open transhiatal esophagectomy (Orringer's technique) with gastric tube reconstruction and cervical anastomosis. The patient did not receive induction chemoradiotherapy before the esophagectomy. Two attempts of surgical repair of fistula failed and the patient died. Being aware of warning signs such as dyspnea and respiratory distress accompanied by bilious content in the tracheal tube is helpful in the early detection and treatment of this type of fistula.

Özofagus Kanseri Nedeni ile Uygulanan Ivor-Lewis Operasyonu Sonucu Gelişen Katastrofik Komplikasyonlar: Olgu Sunumu

“…Medikal minör komplikasyonlar; fi zyolojik bozukluklar, aritmi, üriner sistem enfeksiyonları, diyare iken, majör komplikasyonlar kalp krizi, kalp yetmezliği, tromboembolik olaylar, pnömöni ve solunum yetmezliğidir. Cerrahi minör komplikasyonlar; yara enfeksiyonu, minör pnömotorax iken, majör komplikasyonlar anastomoz kaçakları, gastrotomi kaçakları, gastrik nekroz, toraks içine kanamalar, laringeal sinir paralizisi, ampiyem, gastro-mediastinal fi stül, bronkomediastinal fi stüldür (3)(4)(5). Operasyon sonrasında gelişen majör komplikasyonların tanısı mümkün olan en kısa sürede konulup tedavisi geciktirilmemelidir.…”

Application of combined-type Y-shaped covered metallic stents for the treatment of gastrotracheal fistulas and gastrobronchial fistulas

“…Surgical repair of the fistula, which includes tracheal resection, lower lobectomy, or the creation of a muscle flap, may impose an excessive burden on a debilitated patient. [5][6][7] Recent developments in interventional therapy have led to the increasing use of airway stents for the treatment of airway-gastric fistulas. However, in the early stages of the application of this therapy, the placement of a single or multiple L-or Y-shaped tubular stents was associated with a high dislocation rate; moreover, in the case of large fistulas, complete sealing was difficult to achieve, and thus, the clinical application of this intervention was limited.…”

“…[1][2][3][4] The formation of fistulas between the tracheobronchial tree and the stomach in the late postoperative period after gastric pull-up surgery is most often caused by tumor recurrence, radiation necrosis, and tracheobronchial erosion along the gastric staple line. [5][6][7] A covered metallic esophageal stent would be the first choice for the management of GTFs and GBFs, but most often the clinician faces a situation in which the esophageal stent should have a larger diameter on the gastric side making stenting the alimentary side of the fistula insufficient. 5 Moreover, the risk of migration is high for stents placed in the gastric pull-up segment.…”