Anoldo Pietro, Vertaldi Sara, Manigrasso Michele, D'Amore Anna, De Palma Giovanni Domenico, Milone Marco
Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy.
Department of Clinical Medicine and Surgery, Federico II University of Naples, Via Sergio Pansini, 5, 80131 Naples, Italy.
Int J Surg Case Rep. 2023 Feb;103:107876. doi: 10.1016/j.ijscr.2023.107876. Epub 2023 Jan 10.
Gastric conduit dehiscence after esophagectomy represents a severe complication associated with high mortality. Surgical management is achieved through thoracotomy, but often ends up in conduit sacrifice and diversion.
A 59-years-old man underwent minimally invasive McKeown esophagectomy for esophageal adenocarcinoma. After a worsening of the postoperative course and evidence at the CT scan and endoscopy of highly suspect gastric conduit failure, the patient underwent an exploratory thoracoscopy, which revealed a partial dehiscence of the gastric conduit treated with resection of the dehiscent gastric wall by a linear stapler on the guide of a 36-french orogastric tube. Patient had a regular postoperative course without any complications and was discharged on the 6th postoperative day.
The management of conduit necrosis is extremely challenging. There are several interventional options and it is difficult to decide the most appropriate treatment for each individual patient. In our case we decided to perform a reintervention with a thoracoscopic approach, resecting the dehiscent area of the gastric conduit.
Minimally invasive surgery is a valid option for the management of post-operative complications, including those in emergency setting. Re-suturing a partial dehiscence of gastric conduit may be feasible if tissue conditions allow.
食管切除术后胃管道裂开是一种严重并发症，死亡率高。手术治疗通过开胸进行，但往往最终导致胃管道牺牲和改道。
一名59岁男性因食管腺癌接受了微创McKeown食管切除术。术后病情恶化，CT扫描和内镜检查显示高度怀疑胃管道衰竭，患者接受了 exploratory thoracoscopy，发现胃管道部分裂开，在一根36法式口胃管的引导下，使用线性吻合器切除裂开的胃壁进行治疗。患者术后恢复正常，无任何并发症，术后第6天出院。
胃管道坏死的处理极具挑战性。有多种干预选择，很难为每个患者确定最合适的治疗方法。在我们的病例中，我们决定采用胸腔镜方法进行再次干预，切除胃管道的裂开区域。
微创手术是处理术后并发症（包括紧急情况下的并发症）的有效选择。如果组织条件允许，重新缝合胃管道的部分裂开可能是可行的。
