Inflatable mediastinoscopic esophagectomy for refractory benign esophageal fistulas: An effective therapeutical methods.

Objective: For refractory benign esophageal fistulas unresponsive to endoscopic therapy, inflatable mediastinoscopic esophagectomy with primary reconstruction effectively addressed thoracic adhesions in 6 cases. Methods: We conducted a retrospective analysis of 6 patients with refractory benign esophageal fistulas treated, documenting etiology, preoperative treatment, surgical techniques, and postoperative results. Results: The causes were spontaneous esophageal rupture in 2 cases and iatrogenic damage in 4 cases. Disease duration ranged from 1 month to 13 years. One patient had an esophagopulmonary fistula, and 5 patients had empyema. The upper and intermediate esophagus were dissected using inflatable mediastinoscopy. The lower esophagus was dissected using laparoscopy (4 cases) or laparotomy (2 cases). All patients underwent gastric tube reconstruction with a cervical hand-sewn anastomosis. One patient experienced a cervical anastomotic leak, which was resolved with drainage within 2 weeks. The esophagopulmonary fistula resolved on the first postoperative day, and the empyema was cured in 3 to 4 weeks. Conclusions: Inflatable mediastinoscopic esophagectomy with primary gastric tube reconstruction is a safe and effective treatment for refractory benign esophageal fistulas that have failed conservative therapies.