Abstract
Introduction:
Gastropleural fistula (GPF) is a complex problem that develops secondary to surgery, trauma, peptic ulcer disease, malignancy, radiation, or chemotherapy. 1 –12 Management typically includes endoscopic or surgical intervention along with intra-abdominal or intrathoracic drainage of preexisting infection. 8,12 Traditionally, surgical approaches have been performed through a laparotomy or thoracotomy, subjecting already ill patients to additional morbidity. 1,2,4,7 This video demonstrates a laparoscopic minimally invasive approach to the management of a GPF with a wedge resection of the stomach.
Case Report:
The patient is a 58-year-old female with a remote history of a Nissen fundoplication who was admitted to the intensive care unit at an outside institution for pneumonia. She developed a GPF after a video-assisted thoracoscopic surgical decortication for an empyema and was taken to the operating room for a laparoscopic exploration. The Nissen fundoplication was undone and a large defect was noted on the fundus of the stomach. The defect was resected with sequential staplers and oversewn. The patient recovered and was discharged from the hospital without further complications. She was seen in clinic for follow-up at 2 weeks and 1 month and was tolerating a soft diet and recovering from her hospitalization well.
Conclusion:
GPF can be a difficult disease to treat as the patients may be both acutely and chronically ill. GPF repair can be performed via laparoscopy and may lead to improved patient outcomes and faster recovery.
No competing financial interests exist.
Runtime of video: 6 mins 47 secs
This video was previously presented at the 2016 SAGES meeting.
Get full access to this article
View all access options for this article.