VA01.6. When Two Lumens communicate: Laparoscopic Tho

Abstract

Esophageal Cancer: Other Broncho-esophageal fistula is a rare but can be a life-threatening condition associated with high morbidity and mortality.It leads repeated onset of pneumonia requiring hospitalisation and decreased Quality of life. Surgical management is challenging due to contamination, local inflammation,post radiation fibrosis and poor tissue quality. Vascularized tissue interposition using omentum offers biological advantages. We report a minimally invasive combined thoracoscopic and laparoscopic approach for definitive repair using an omental flap. A patient with carcinoma esophagus post definitive chemoradiation in 2014 .Until 2020 ,he was doing fine and Due to repeated cough and pneumonias,he underwent evaluation and diagnosed to have esophago left lower lobe segmental -bronchial fistula .A vascularized omental flap was harvested laparoscopically and transposed into the thoracic cavity. He underwent laparoscopic and thoracoscopic exploration. The fistulous tract was identified, and both esophageal and bronchial defects were closed with clips. intraoperative endoscopy guided identification of fistula and intraoperative guided insufflation with no leak at fistula site was helpful. laparoscopically harvested omental flap was interposed between the repaired esophagus and bronchus to reinforce the repair and prevent recurrence. The procedure was completed entirely using minimally invasive techniques without conversion to open surgery. The omental flap provided well-vascularized tissue coverage over the repair site. Postoperatively, the patient had an uneventful recovery with no evidence of leak or recurrent fistula on follow-up imaging and endoscopic evaluation. Oral intake was resumed gradually, and the patient remained asymptomatic during follow-up. A combined thoracoscopic and laparoscopic approach using a vascularized omental flap is a feasible and effective minimally invasive option for the management of complex broncho-esophageal fistula . This technique offers the advantages of reduced surgical trauma, excellent tissue reinforcement, and satisfactory clinical outcomes in a challenging surgical scenario. 1.intraoeprative endoscopy to identify fistula site 2.laparoscopic harved omental flap 3.dissection of distal esophagus laparoscopically transhiatal approach 4.ometal flap positioning into thoracic cavity 5.thoracic dissection at fistula site 6.identification and clipping of fistula site 7.omental transposition at fistula site