CASE REPORT article
Front. Oncol.
Sec. Gastrointestinal Cancers: Gastric and Esophageal Cancers
Thoracoscopic Repair of Esophagogastric Anastomotic Fistula Using a Pedicled Pleural Flap: A Case Report and Literature Review
Provisionally accepted
- 1Kunming Medical University, Kunming, China
- 2The Affiliated Hospital of Yunnan University, Kunming, China
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BACKGROUND Esophagogastric anastomotic leakage is one of the most serious complications following radical esophagectomy for esophageal cancer. Anastomotic leakage leads to prolonged hospitalization, increased medical costs, reduced quality of life, and higher mortality. Thus, early detection and effective treatment of this complication are crucial. Successful treatment of anastomotic fistula hinges on closing the fistula tract.CASE SUMMARY We treated a patient with locally advanced mid-thoracic esophageal squamous cell carcinoma. After two cycles of neoadjuvant chemotherapy, he underwent minimally invasive thoracoscopic esophagectomy using the McKeown procedure. However, on postoperative day 11, he developed a left cervical esophagogastric anastomotic leakage that extended into the right thoracic cavity, leading to empyema formation. After controlling the acute infection, we innovatively used a parietal pleural pedicled flap, assisted by video-assisted thoracoscopy, to repair the anastomotic fistula. Additionally, we performed thoracoscopic fiberboard decortication for the empyema. Subsequent measures included continuous low-pressure negative pleural suction in the right thoracic cavity to promote pulmonary re-expansion and eliminate residual cavity, as well as continuous irrigation and drainage to maintain a clean postoperative environment in the right thoracic cavity. These comprehensive treatments led to complete healing of the esophagogastric anastomotic fistula, and the patient had an uneventful recovery without any sequelae.CONCLUSION This case demonstrates that pedicled pleural flaps are a viable and practical option for repairing anastomotic fistulas. Our treatment approach offers advantages of simplicity, practicality, and minimal invasiveness, providing a reference for managing esophagogastric anastomotic fistula patients.
Keywords: Empyema, Esophagogastric anastomotic leakage, Minimally invasive esophagectomy, Pedicle pleural flap, Thoracoscopy
Received: 31 Aug 2025; Accepted: 17 Dec 2025.
Copyright: © 2025 Li, Deng and Zou. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yongjun Deng
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