MANAGEMENT OF MALIGNANT BRONCHOESOPHAGEAL FISTULAS

  • 1 January 1983
    • journal article
    • research article
    • Vol. 157  (3) , 201-204
Abstract
Twenty-four patients with a bronchoesophageal fistula due to a malignant lesion were seen during the 8 yr from 1974 to 1981. Twenty of the patients had carcinoma of the esophagus, and 4 patients had carcinoma of the lung. All 3 patients who had a Celestin tube inserted had gastric reflux, and in 2, the fistula was not completely occluded. Four patients who had a cervical esophagostomy, feeding jejunostomy and ligation of the gastroesophageal junction died in the immediate postoperative period. The best palliative result was achieved in 17 patients who had a bypass of the fistula with the stomach. Fourteen had a substernal gastric bypass to the cervical portion of the esophagus, and 3 patients had a gastric bypass to the upper thoracic portion of the esophagus by way of a right thoracotomy. Although operative death occurred in 6 of 17 patients, the surviving patients resumed oral feeding within 10-14 days after operation, and the pneumonias cleared. These patients had, by far, by the best palliative result. Substernal or intrathoracic bypass of the bronchoesophageal fistula is advocated as soon as the general condition of the patient permits.

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