Re-thoracoscopy for the management of gastric conduit dehiscence after minimally invasive McKeown esophagectomy. (February 2023)

• Record Type: Journal Article
• Authors: Anoldo, Pietro; Vertaldi, Sara; Manigrasso, Michele; D'Amore, Anna; De Palma, Giovanni Domenico; Milone, Marco
• Is Part Of: International journal of surgery case reports. Volume 103(2023)
• Publication Date: 2023-02
• Subjects: Gastric conduit dehiscence -- Minimally invasive esophagectomy -- Emergency thoracoscopy -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2023.107876
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: 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. Case presentation: 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. Clinical discussion: 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. Conclusions: 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. Highlights: Gastric conduit dehiscence after esophagectomy represents a severe complication associated with high mortality. Sectioning a dehiscent gastric conduit and re-suturing may be feasible if tissue vitality is demonstrated. Suturing the defect and pulling it is an effective trick that allows optimal exposure of the tissue to be resected. Minimally invasive surgery is a valid option for the management of complications after esophagectomy.