Two cases of benign tracheo-gastric fistula following esophagectomy for cancer.

Abstract

Two successfully managed cases of esophageal replacement for cancer complicated by neoesophagotracheal fistula are described. In both cases radical esophagectomy with a gastric pull-up was performed. In the postoperative period different complications necessitated prolonged ventilatory support and tracheostomy. In both cases a tracheo-gastric fistula developed probably because of the ischaemic effort of the tracheostomy tube and the nasogastric tube. At single stage repairs, the fistulae were divided and the gastric defects were closed directly. In the first case resection of four strictured tracheal rings and tracheal anastomosis had to be performed. In the second case the fistula was recognized earlier and stricture did not develop. The defect on the membranous trachea was patched with autologous fascia lata graft. A left pectoralis major muscle flap was interposed between the trachea and the pulled up stomach in both cases to prevent recurrence of the fistula. Treatment of this potentially life-threatening and rare condition yielded excellent results.