T-drain esophagostomy under thoracoscopy for intrathoracic esophagogastric anastomotic leakage following esophagectomy for esophagogastric junction cancer: A case report.

INTRODUCTION: Intrathoracic esophagogastric anastomotic leakage is considered the most severe complication. We successfully performed T-drain esophagostomy under thoracoscopy for intrathoracic esophagogastric anastomotic leakage.

PRESENTATION OF CASE: A 44-year-old man visited a local hospital because of vomiting during the night. Upon examination, the patient was diagnosed with c-T2N0M0 stage II adenocarcinoma in Barrett's esophagus. We performed laparoscopic proximal gastrectomy and lower esophagectomy and gastric conduit reconstruction using the posterior mediastinal route with intrathoracic anastomosis under thoracoscopy. The patient developed fever, chest pain and dyspnea on postoperative day 5. We diagnosed anastomotic leakage and performed reoperation via thoracoscopy. The perforation, which was approximately 8 mm in length, was found on the back side of the esophagogastric anastomosis. There was no clear finding of necrosis in the gastric tube or the esophagus. After sufficiently deterging the thoracic cavity, a T-drain was inserted through the perforation and fixed. After fistula formation, the T-drain was slowly phased out. The postoperative course was uneventful.

DISCUSSION: It is important to note that early treatment of severe leaks is mandatory to limit related mortality. However, current therapies for treating anastomotic leakage are still inefficient and controversial.

CONCLUSION: T-drain esophagostomy under thoracoscopy for intrathoracic esophagogastric anastomotic leakage could be minimally invasive and effective.