Thoracoscopy–thoracotomy approach for an aortoesophageal fistula: a case report

• Published in: General thoracic and cardiovascular surgery Vol. 69; no. 1; pp. 168 - 171
• Main Authors: Isagawa, Yuriko, Kanetaka, Kengo, Yoneda, Akira, Matsumaru, Ichiro, Miura, Takashi, Eishi, Kiyoyuki, Eguchi, Susumu
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 2021; Springer Nature B.V
• Subjects: Abscesses; Adult; Aneurysms; Antibiotics; Aortic Aneurysm, Thoracic - surgery; Aortic Diseases - surgery; Blood; Cardiac Surgery; Cardiology; Case Report; Case reports; Coronary vessels; Esophageal Fistula - diagnostic imaging; Esophageal Fistula - etiology; Esophageal Fistula - surgery; Esophagectomy; Esophagus; Fistula; Hospitals; Humans; Infections; Male; Medicine; Medicine & Public Health; Ostomy; Patients; Prostheses; Surgeons; Surgery; Surgical Oncology; Thoracic Surgery; Thoracoscopy; Thoracotomy; Vascular Fistula - diagnostic imaging; Vascular Fistula - etiology; Vascular Fistula - surgery; Less invasive; Thoracoscopic esophagectomy; Two-staged operation; Aortoesophageal fistula
• ISSN: 1863-6705; 1863-6713
• DOI: 10.1007/s11748-020-01553-6

An aortoesophageal fistula is often fatal, and standard radical surgery is highly invasive because both bilateral thoracotomy and laparotomy are required. We successfully incorporated thoracoscopic esophagectomy into this procedure for a 43-year-old man with an aortoesophageal fistula. After detaching the esophagus from the adjacent tissue, and leaving just the fistula in the right thoracoscopic procedure, we performed an open aortic graft replacement. Subsequently, we created an omental pedicle graft and wrapped it over the graft. Through this thoracoscopy–thoracostomy approach, minimal destruction of the right thoracic wall was achieved and the successful dissection of the diseased esophagus could be carried out while reducing the amount of bleeding during anticoagulation for cardiopulmonary bypass, and the field of view for the aortic replacement was not disturbed during left thoracotomy. Four months later, we reconstructed the esophagus by a pedunculated small intestinal graft through the ante-thoracic route. A thoracoscopy–thoracotomy approach is therefore considered to be effective and useful for treating a patient with an aortoesophageal fistula.