THORACOPLASTY IN THE MANAGEMENT OF ESOPHA GOPLEURAL FISTULAS AFTER PNEUMONECTOMY

Esophagopleural fistula (EPF) after pneumonectomy is an unusual but se rious complication. Complex surgical procedures are needed in order to treat this complication. Between May 1993 and August 1994, 3 cases we re observed in patients aged 41, 63 and 73 years. All patients underwe nt extensive pneumonectomy for carcinoma(right 2, left = 1). EPF prese nted early in one case (7th day) and late in the other two cases (4th and 30th month). Diagnosis was always established by gastrographin swa llow. There was no evidence for carcinoma recurrence. In two cases the first step of management was pleural drainage and lavage plus a feedi ng jejunostomy. The second-step procedure was performed after improvem ent of the general condition and consisted of thoracoplasty with resec tion of the second to eight ribs. In one case with late minimal leakag e thoracoplasty was the only procedure. The quality of pleural collaps e was adequate in every case to allow oral feeding after a variable ti me interval (8th day, 30th day, 75th day). In two cases, oral feeding was started despite a persistent directed esophageal cutaneous fistula , which closed subsequently. In our experience, thoracoplasty is a sim ple and reliable method for treating this type of EPF, and may be an a lternative to direct closure of the fistula or bipolar esophageal excl usion.