Treatment of an acquired esophageal-bibronchial benign fistula using an original combination of techniques

a Divison of General Thoracic Surgery, Maggiore and Bellaria Hospitals, Bologna, Italy b Thoracic Endoscopy and Pulmonology Unit, Maggiore and Bellaria Hospitals, Largo B. Nigrisoli 2, 40133 Bologna, Italy *Corresponding author. Tel.: +390516478802; fax: +390516478209. E-mail address : rocco.trisolini{at}ausl.bologna.it (R. Trisolini). We report on the successful surgical treatment of an esophageal-bibronchial fistula originating from an iatrogenic mediastinal abscess. Endoscopic treatment had been excluded due to the extensive damage to the right main stem bronchus wall. The surgical treatment was carried out as follows: 1) Endoscopic stenting of the left main bronchus with a self-expanding metallic stent followed by selective left main bronchus intubation; 2) Laparotomic harvesting of the omentum pedicled on both gastro-epiploic vessels; 3) Right thoracotomy, complete dissection of both main bronchi and esophageal wall at the site of the leakage; 4) Harvesting of a pericardial vascularized graft; 5) Deployment of a self-expanding metallic stent from the surgical field into the right main stem bronchus; 6) Reconstruction of the right bronchus wall with the pericardial patch; 7) Positioning a T-tube in the esophageal leak; and 8) Intrathoracic transposition of the omental graft for buttressing all sutures and potential leakage points. The postoperative course was uneventful from a surgical point of view and the patient recovered completely. Key Words: Esophageal fistula; Bronchial fistula; Bronchial stent; Pericardial patch