Surgical repair of benign thoracogastric airway fistula after esophagectomy using a pedicled myocutaneous flap.

Abstract

Thoracogastric airway fistula (TGAF) is a rare but devastating complication that may occur following esophagectomy. The most effective method for repairing the defect between the airway and digestive tract is the interposition of a pedicled soft tissue in situ. However, this approach is associated with a high risk and remains challenging for surgeons. Herein, we present a two-stage surgical approach using a pedicled myocutaneous flap for TGAF repair. In Stage I, an appropriate pedicled myocutaneous flap was selected and prepared based on the patient's surgical history. Then, the thoracostomach was removed transthoracically to expose the tracheal fistula, and the pedicled myocutaneous flap was used to repair the fistula by anastomosing it to the airway. At the same time, cervical esophagostomy and jejunostomy were performed. In Stage II, 3-6 months later, the ileocolon was freed in the abdomen and pulled up behind the sternum to the neck to complete the reconstruction of the digestive tract. The staged repair of TGAF using pedicled myocutaneous flaps appeared safe, with no intraoperative adverse events, including anesthesia accidents, massive bleeding, and severe arrhythmia. One patient developed a tracheal-myocutaneous flap anastomotic leakage 1 week after surgery, resulting in chronic empyema. After 1 month of conservative treatment, follow-up bronchoscopy revealed good healing of the anastomosis. No surgery-related complications occurred in the other patients. Four patients underwent successful repair of TGAF using this approach and were able to resume oral intake. Successful repair using a pedicled myocutaneous flap may provide a reference for treating this type of disease.