Operative Management of a Rare Gastrobronchial Fistula

The development of a gastrobronchial fistula is a relatively rare occurrence. The patient in this video underwent esophagectomy for esophageal cancer and a stomach pull-up operation was performed. A few weeks later, the patient experienced chest infection and pneumonia due to repeated aspiration. Further investigations including computed tomography, a contrast swallow study, and esophagogastroscopy confirmed the presence of a fistulous communication between the stomach—the neo-esophagus—and the intermediate bronchus. This required operative intervention as it was sizeable, about 1.5 cm.

The authors performed a right redo thoracotomy, mobilized the lung, identified the fistulous communication, and verified this by intraoperative bronchoscopy. The gastric fistula was closed over a T-tube that was exteriorized through the right chest wall.  The authors harvested a longitudinal vascularized strip of diaphragm. The diaphragm was primarily closed using Prolene® and mesh. The vascularized diaphragm pedicle was then used to close the bronchial fistula using interrupted Prolene sutures, and a very good repair was confirmed on intraoperative bronchoscopy and with an air-leak test.