Gastropleural Fistula Repair: the Hidden Dangers of VATS Decortication

Ran B Luo, MD, Shanglei Liu, MD, Jonathan C DeLong, MD, Alisa M Coker, MD, Caitlin Houghton, MD, Bryan J Sandler, MD, FACS, Garth R Jacobsen, MD, FACS, Santiago Horgan, MD, FACS. University of California, San Diego

This video demonstrates the laparoscopic repair of a gastro-pleural fistula that developed after a video- assisted thorascopic (VATS) decortication. The patient had a remote history of a Nissen fundoplication. She developed a complicated course of pneumonia, which progressed into a left sided empyema that eventually required operative debridement. A left sided thorascopic decortication was performed at the outside hospital, but her postoperative course was complicated by the formation of a left sided gastro-pleural fistula. She was then transferred to our hospital for further management. The key steps of initial endoscopy, lysis of adhesions, reduction and dissection of the previous wrap, proper resection of the fistula, with pre and post-operative imaging studies are shown and described.

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