Improved three-tubing approach for the reoperation of perforation suturing anastomotic fistula after radical radiotherapy of upper thoracic esophgeal squamous cell carcinoma

Honggang Ke, Hui Zhao, Xiaojun Qiu, Hanxuan Dong, Qingsheng You


Background: As we all know that traditional three tubes treatment for the anastomotic fistula after esophagectomy is easy and efficient, but there are still so many problems such as pain, intubation discomfort, psychological pressure and prognosis slowly. Our report would introduce a new method to cure the anastomotic fistula for the patient after radical radiotherapy.
Methods: CT and DSA-guided percutaneous cervical gastric wall puncture were performed for the patient while the Flocare tube was introduced entering the mediastinum via the anastomotic fistula under the guidance of contrast medium followed by the procedure of persistent vacuum-suction for 24 hours. Meanwhile, the patient underwent the treatments such as fasting, gastrointestinal decompression, anti-inflammation and nutritional support.
Results: Four months later, the patient was discharged after the healing of gastroesophageal anastomotic fistula, significant shrink of tracheo-mediastinal fistula and no discomfort when taking semi-liquid diet.
Conclusions: With the benefits of long-term tube retention, improved three-tubing will lead to positive and effective treatment, especially for the patient who has the healing capacity of the tissue decreases due to radical radiotherapy.