Video-assisted thoracic surgery (VATS) in the surgical management of acquired benign broncho-esophageal fistula

Abstract

Background

Benign broncho-esophageal fistula (BEF) is a rare condition that often results from infections, trauma, or prior surgical interventions. This study evaluates the outcomes of surgical management of BEF, emphasizing the role of video-assisted thoracoscopic surgery.

Methods

A retrospective analysis of 19 patients who underwent surgical management for benign BEF was conducted. Patient demographics, fistula characteristics, surgical approach, perioperative outcomes, and complications were assessed.

Results

The cohort comprised 14 males (73.7%) and 5 females (26.3%) with a median age of 34 years (range: 19–63 years). The left main bronchus was the most common fistula location (n = 10, 52.6%) followed by right lower lobe (n = 6, 31.6%), left lower lobe (n = 2, 10.5%), and right bronchus intermedius (n = 1, 5.3%). A prior history of antitubercular treatment was noted in 15 patients (79%). Video-assisted thoracic surgery was successfully performed in 17 patients (89.5%), while 2 (10.5%) required conversion to thoracotomy due to dense adhesions. During surgery, division of fistula alone was performed in 14 patients (73.7%). The distal lung destruction necessitated lobectomy in 3 patients (15.78%) and wedge resection in 2 patients (10.52%). The mean operative time was 120 min, with a median hospital stay of 5.5 days. Two patients (10.5%) experienced complications, including a minimal esophageal leak managed with a stent and a case of postoperative pneumonia which resolved with conservative measures. No recurrences were observed during a median follow-up of 48 months.

Conclusions

Video-assisted thoracic surgery is a safe and effective approach for managing benign BEF, offering excellent long-term outcomes with minimal morbidity. Conversion to thoracotomy is required in select cases with dense adhesions.