A combined technique using a muscular flap and endobronchial stent to repair complex broncho-oesophageal fistulae supported by ECMO.

Publisher: Taylor & Francis Country of Publication: England NLM ID: 0370571 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 0001-5458 (Print) Linking ISSN: 00015458 NLM ISO Abbreviation: Acta Chir Belg Subsets: MEDLINE

Publication: 2016- : London : Taylor & Francis
Original Publication: Bruxelles : Acta Medica Belgica

Stents*; Bronchial Fistula/*therapy ; Chemoradiotherapy/*adverse effects ; Esophageal Fistula/*therapy ; Esophagectomy/*adverse effects ; Surgical Flaps/*transplantation; Aged ; Bronchial Fistula/diagnostic imaging ; Bronchial Fistula/etiology ; Carcinoma, Squamous Cell/pathology ; Carcinoma, Squamous Cell/therapy ; Chemoradiotherapy/methods ; Combined Modality Therapy ; Emergencies ; Esophageal Fistula/diagnostic imaging ; Esophageal Fistula/etiology ; Esophageal Neoplasms/pathology ; Esophageal Neoplasms/therapy ; Esophagectomy/methods ; Extracorporeal Membrane Oxygenation/methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Myocutaneous Flap/transplantation ; Respiratory Distress Syndrome/diagnosis ; Respiratory Distress Syndrome/etiology ; Risk Assessment ; Sampling Studies ; Tomography, X-Ray Computed/methods ; Treatment Outcome

Introduction: Certain broncho-oesophageal fistulae require surgical repair. Herein, we describe an innovative surgical technique combining intercostal flap and endobronchial stenting.
Case Reports: Two patients, each with a with complex broncho-oesophageal fistula 2 years after radio-chemotherapy, were hospitalised for severe respiratory infection and extension of the fistula despite previous endoscopic treatment. The first patient presented with respiratory distress (ARDS). She had emergency surgery under extra corporeal membrane oxygenation: oesophagectomy and reconstruction of the left bronchus by a vascularised intercostal flap. Stenting was performed on day 10, due to persistence of the fistula. At 3 months the bronchus was healed, but the patient died of cerebral bleeding. For the second patient, repair was proposed before severe ARDS with the same surgical and ventilatory strategy and a stent was preventively inserted after surgery. After 3 months, the stent was removed and the left bronchus was healed.
Conclusions: Complex post-radiotherapy broncho-oesophageal fistulae should be treated surgically before respiratory complications arise, by combining reconstruction with a vascularised flap and transient stenting.

Keywords: ARDS; Broncho-oesophageal fistula; endobronchial stent; extra corporeal membrane oxygenation; intercostal flap; prevention surgery

Date Created: 20170708 Date Completed: 20180822 Latest Revision: 20201209

20240829

10.1080/00015458.2017.1284466

28685656