Experiences in the diagnosis and treatment of postoperative esophagopleural sac fistula

Esophagopleural sac fistula is a rare complication of esophagectomy associated with a relatively high mortality rate. To examine the diagnosis and treatment of esophago-mediastinal/pleural sac fistulas, 6 cases of esophago-mediastinal/pleural fistula of different etiologies, with a critical appraisal of current domestic and international clinical research, were analyzed. Our six patients were recovered and discharged from the hospital. Although contrast abdominal computed tomography, using a water-soluble contrast medium, and endoscopy can be used for the diagnosis of esophago-mediastinal/pleural sac fistulas in specific patients, observation of clinical symptoms remains the most important criterion for diagnosis. A standardized evaluation of specific issues is recommended for all patients to effectively determine the need for re-thoracotomy. Stent implantation under endoscopy should be avoided unless absolutely necessary. However, vacuum sealing and drainage of a transesophageal anastomotic stoma can facilitate healing of a leak. Pleural lavage can be used, when necessary, to relieve clinical symptoms and, again, facilitate healing of a leak. Moreover, maintaining intact pleura on the pleural cupula can reduce the risk of a cervical anastomotic fistula from spreading into the chest cavity.