with Dr. Pedro Alvarez de Sierra Hernández
This video shows the steps followed in the treatment of a gastropleural fistula after an Ivor-Lewis procedure for cardial adenocarcinoma uT1N0 in a 56-year-old male patient. A small ischemic area located at the tip of the gastroplasty (not anastomotic) generated a gastric leak first detected as a change in the pleural tube.
Conservative management (nasogastric tube, drains) did not control sepsis, thus resurgery was scheduled. A right thoracotomy, pleurectomy, debridement, and primary suture covered with pleural patch only controlled the fistula for 48 hours. Several endoscopic procedures were attempted for fistula control with no effective result until the endoluminal negative pressure therapy (ESO-SPONGE) was indicated. The infection was then controlled and the esophagogastroplasty preserved.
The patient survived the operation, although he could have been spared the complications had we indicated endoluminal therapy in the first place.
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