Duodenal diversion surgery in management of intractable tracheobroncho-gastric fistula after esophagectomy.

Background: Tracheobroncho-gastric fistula (TGF), a rare but potentially fatal complication following esophagectomy with gastric conduit reconstruction, has conventionally been treated with surgical repair and/or airway stenting. However, satisfactory therapeutic outcomes with these modalities have yet to be obtained because of difficulty in controlling persistent inflammation caused by digestive juice reflux.

Case Presentation: We adopted duodenal diversion (DD), a classic anti-reflux surgical method, as an additional option for TGF management and have experienced two cases undergoing DD surgery for post-esophagectomy TGF (all male, 76-77 years old). TGF was developed after gastric conduit necrosis and anastomotic leakage, respectively, in these patients. In both cases, the DD procedure combined with surgical fistula repair was feasible with no DD-related complications. These operations achieved a good effect in terms of preventing gastroduodenal reflux and ameliorating respiratory status. Reconstructive surgery after DD was performed and oral dietary intake was successfully resumed in one case.

Conclusion: DD appears to be a valid evacuation therapy when airway contamination with gastroduodenal reflux is not amenable to the conventional approach alone, and can usefully be included in the TGF treatment strategy in appropriate cases.