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Laparoscopic sleeve gastrectomy (LSG) is a commonly used procedure in bariatric patients that often has excellent results. Despite its advantages, LSG is burdened by specific intraoperative and postoperative early and late complications. One of the life-threatening complications is gastric fistula, usually treated with a multidisciplinary surgical–endoscopic approach. In case of failure of the latter, alternative nonoperative techniques such as the use of autologous stem cells truly represents an innovative possibility, with only few cases described in literature. Here, we report the case of a 25-year-old man with post-LSG broncho-gastric fistula treated with application of autologous stem cells after the failure of the conventional surgical/endoscopic approach.

The case reported in this paper is a vascular‐bronchial fistula associated with fatal massive hemoptysis. The patient was rescued successfully by experts from a multidisciplinary team. The bronchoscopy physician cleared the accumulated blood in the airway timely and maintained the airway patency, and the anesthesiologist established artificial ventilation quickly; eventually, the thoracic surgeon performed an emergency thoracotomy to control the bleeding. It reflected the significance of multidisciplinary collaborative treatment. The case reported in this paper is a vascular‐bronchial fistula associated with fatal massive hemoptysis. The patient was successfully rescued by experts from a multidisciplinary collaborative team. The bronchoscopy physician timely cleared the accumulated blood in the airway and maintained the airway patency, and the anesthesiologist quickly established artificial ventilation; eventually, the thoracic surgeon urgently performed a thoracotomy to control the bleeding. This reflects the significance of multidisciplinary collaborative treatment.

BackgroundNonmalignant esophago-respiratory fistulas (ERF) are frightening clinical situations, involving surgery with high morbi-mortality rate. We described the endoscopic management of benign ERF. The aim of the study was to describe outcomes of endoscopic treatment of nonmalignant ERF and to analyze factors associated with its success.MethodsThis is a retrospective study involving patients managed for benign ERF in our center between 2012 and 2016. The ERFs were classified into three groups of sizes: (I) punctiform, (II) medium, and (III) large. The primary aim was to document the endoscopic success (= fistula’s healing after 6 months). The secondary objectives were characteristics of endoscopic treatment, the functional success and death, and identifying factors associated with success and death.Results22 patients were included. The etiologies of ERF were surgery in 12 patients, esophageal dilatation in 3, invasive ventilation in 3, radiation therapy in 2, and tracheostomy in 2. Ninety-three procedures were performed (mean of number: 4.2 ± 4.5/patient). Twenty-one patients had stent placement, eight over-the-scope clips (OTSC), and seven a combined therapy. The endoscopic success rate was 45.5% (n = 10; 67% in punctiform, 50% in medium, and 14% in large ERF), and the functional success was 55% (n = 12). Serious adverse events occurred in 9 patients (40.9%). Six patients died (27%). The persistence of the orifice after 6 months of endoscopic treatment was associated with failure (OR 44; IC95: 3.38–573.4; p = 0.004 multivariate analysis). The orifice’s size was associated with mortality [71% of death if large fistulas (p = 0.001) univariate analysis].ConclusionEndoscopic treatment of ERF leads to 45.5% of successful endoscopic closure and 55.5% of functional success, depending on fistula’s orifice size. After 6 months without healing, the chances for success dramatically decrease.

Background Bronchopleural fistulas (BPFs) are severe medical condition with high mortality. When the conventional surgical therapy failed, endobronchial intervention could function as the supplementary option. Several studies reported successful endobronchial managements of BPFs whereas the optimal strategies remain elusive. Methods We retrospectively reviewed the medical records of patients with BPFs underwent endobronchial interventions with Vaseline gauze, shape-adjustable silicone plug, sutured silicone tube or covered metallic stent in our institution. Results From 2018 to 2024, a total of 30 patients (11 females VS. 19 males; mean age 48.03 ± 20.33 years) with primary etiology of tumor ( n  = 19), empyema ( n  = 6), gastro-bronchial fistula ( n  = 1), lung infection with immune suppressed status ( n  = 1) and spontaneous pneumothorax ( n  = 3) were treated. Different occlusive materials were placed including covered metallic stent ( n  = 6), shape-adjustable silicone plug ( n  = 4), sutured silicone tube ( n  = 1) and Vaseline gauze(s) ( n  = 21). The dislocation of devices occurred in two patients with covered metallic stent occlusion. On the first day post procedure, 17 patients (56.7%) had complete resolution of the fistulas, compared with 13 patients (43.3%) had incomplete resolution. At the end of the first week post procedure, 19 patients (63.3%) showed complete resolution and 10 patients (33.3%) with partial resolution, whereas one patient (3.3%) failed to have effective closure of the fistula. The representative computer tomography images showed the closure of fistulas and ameliorated hydropneumothorax. Conclusion Four endobronchial interventional maneuvers, the Vaseline gauze, shape-adjustable silicone plug, sutured silicone tube and covered metallic stent, showed both safe and effective managements for patients with BPFs.

Background Retained surgical items pose a significant risk to patient’s safety, with an estimated occurrence of 1 in 5500 procedures. Gossypibomas, also referred to as retained surgical sponges, are items unintentionally left in the cavities of the body after surgery. These adverse events can lead to secondary surgical procedures, readmissions, and infections. Case summary A 24-year-old Somalian male patient presented with persistent coughing, black sputum, and halitosis. His medical history included a laparotomy for a 5-year-old stab wound and penile amputation following a missile injury 15 years back. Physical examination revealed pale conjunctiva, pallor in the oral mucosa, and spoon-shaped fingernails. A chest X-ray demonstrated a ball-like consolidation in the lower left chest, and a thoracic computed tomography scan revealed a soft tissue lesion. The patient underwent thoracotomy and laparotomy, along with a left lower lobe lobectomy due to a bronchopleural fistula caused by a large abdominal surgical sponge invading the lung parenchyma, forming a cavitary lung mass. Diaphragmatic defect was repaired and resection of the gastric perforation using a stapler was performed. The patient’s postoperative course was uneventful. Conclusion Gossypibomas should be considered as a potential differential diagnosis in patients presenting with thoracoabdominal soft tissue masses and having a history of prior surgery. This is especially relevant in cases involving gynecological or emergency surgeries, female sex, or individuals with a high body mass index. A detailed medical history and appropriate imaging are essential for timely diagnosis.

Oesophageal duplication cysts are a subtype of foregut cysts, associated with the presence of ectopic gastric mucosa. Gastric acid secreted by this mucosa can lead to complications. We report one such unusual case of complication leading to the formation of broncho-oesophageal fistula in a duplication cyst. A girl in her middle childhood presented with a long-duration cough and multiple respiratory infections. On investigation, a right-sided paraoesophageal air-filled cystic lesion was identified, with a possible communication with the airway, confirmed by an oral contrast study. On further workup, a positive uptake was noted on Meckel’s scan, signifying the presence of ectopic gastric mucosa. The findings were confirmed surgically and on histopathology and were consistent with a duplication cyst with broncho-oesophageal fistula. An unexplained upper respiratory tract symptomatology should mandate imaging, which would enable early detection and appropriate surgical management of such cysts in infancy and childhood.

Background A broncho-esophageal fistula (BEF) is a medical and surgical disaster. Treatment of BEF is often limited to palliative stent treatment that may migrate or cause erosions and tissue necrosis. Surgical repair of BEF is the only established definite treatment. Case presentation BEF presented in a 40-year-old female patient 8 years after curative treatment with pneumonectomy and radio-chemotherapy for advanced lung cancer. She had autoimmune comorbidity, a single lung, vocal cord paralysis and an extremely hostile thorax. Multi-disciplinary collaboration, close patient involvement and evaluation by the hospital medical ethics committee were key elements in the following treatment course. After temporary stent treatment, a carefully staged surgical marathon was performed: Veno-venous ECMO was established to secure oxygenation, and bilateral thoracotomy and laparotomy performed to access structures in the frozen mediastinum. After extensive thoracoplasty and high-risk dissection, esophagectomy was performed and the 20 × 35 mm bronchial defect repaired by bronchoplasty with a latissimus muscle flap. It was complicated by thrombotic occlusion of the upper venous system, repeated postoperative bleedings and critical illness neuropathy. The patient recovered and was discharged 150 days after surgery. Within 1–2 years bronchoscopy showed a smooth undiscernible bronchoplasty with a stable open left main bronchus. At 5 years the patient lives an independent life at home with her family. Conclusions Surgical treatment of BEF in an extremely complex patient may turn out successfully. It demands careful ethical considerations, comprehensive surgical strategy, multi-disciplinary teamwork, and shared decision making with the patient. The patient presented in this case report is closely followed up with good life quality after 5 years.

Bariatric surgery, particularly sleeve gastrectomy (SG), has emerged as an effective long-term treatment for morbid obesity. Despite its benefits, howver, it may result in severe complications. One rare but serious postoperative issue is the development of a gastrobronchial fistula (GBF), a condition with a challenging diagnosis and management pathway due to its insidious nature. We report the case of a 36-year-old woman who underwent sleeve gastrectomy in 2015. The early postoperative course was complicated by a gastric fistula that was managed with double pigtail stents. Subsequently, the patient developed recurrent bronchopulmonary infections, and imaging in 2017 revealed a GBF connecting the gastric remnant to the bronchial tree. Initial endoscopic management with stenting failed because of migration. Definitive surgical management involved complex adhesiolysis and creation of tension-free fistula-jejunal anastomosis. Postoperative recovery was uneventful, and the patient remains asymptomatic. Gastrothoracic fistula post-bariatric surgery is a rare but potentially life-threatening complication. Their development is often linked to the insufficient treatment of early gastric leaks or collections. Diagnosis is frequently delayed owing to nonspecific respiratory symptoms. Endoscopic approaches have show limited success, and surgical management, often complex, is frequently necessary. Multidisciplinary strategies, including endoscopic and surgical options, are vital for achieving favorable outcomes. Gastrobronchial fistulas represent a diagnostic and therapeutic challenge following sleeve gastrectomy. A high index of suspicion, long-term follow-up, and tailored multidisciplinary approach are essential for effective management and resolution. Awareness of this rare complication should prompt early detection and intervention to reduce the morbidity and mortality.

Treatment of postpneumonectomy empyema remains challenging, especially in presence of bronchopleural fistula. We analysed clinical outcome data of patients with and without bronchopleural fistula undergoing an accelerated empyema treatment concept. From November 2005 to July 2020, all patients with postpneumonectomy empyema were included. Therapy consisted of repeated surgical debridement of the pleural cavity, evaluation for loco-regional flap, negative pressure wound therapy and definitive closure after installation an antibiotic solution in the cavity. Primary endpoint was perioperative mortality, focusing on comparison between patients with (= group A) and without bronchopleural fistula (= group B). Secondary endpoints were empyema resolution/recurrence and length of stay. 58 patients underwent the treatment concept: 19 (32.8%) with bronchopleural fistula. Patients’ mean age was 62.7 ± 11.5 years. Nine patients (15.5%) deceased within 30 days: 3 (15.8%) in group A, 6 (15.4%) in group B. 90-days mortality tends to be lower in group A (n = 3 (15.8%)) compared to group B (n = 11 (28.2%)) ( p  = 0.078). Incidence of postoperative complication was 63.2% (n = 12) in group A compared to 56.4% (n = 22) in group B ( p  = 0.316). Postpneumonectomy empyema resolution was 100% in the cohort. 3 patients (15.8%) in the group A and 3 (7.7%) in group B ( p  = 0.175) developed an empyema-recurrence, successfully managed with the treatment concept again. Mean hospital length of stay was lower in group A (24.6 ± 9.5 days vs 27.2 ± 24.3 days in group B; p  = 0.329). With our accelerated treatment concept, postpneumonectomy empyema with bronchopleural fistula could effectively and safely be treated while maintaining integrity of the chest wall. Clinical Registration Number: KEK-ZH-NR: 2021-01114.

Introduction Persistent air leaks, such as bronchopleural fistulas, cause significant health challenges and diagnostic conundrums in both adult and pediatric patients, often delaying recovery and increasing the risk of severe complications. Traditional treatments include prolonged chest tube placement, ventilator manipulation, medical pleurodesis, extracorporeal membrane oxygenation, or surgery, including lobectomy. While used in adult patients, endobronchial valve placement is an emerging, minimally invasive option for treating persistent air leaks in children who have failed other interventions and are not surgical candidates. Case presentation This unique case describes an 8-year-old Hispanic female with chronic respiratory failure secondary to tracheobronchomalacia and pulmonary hypoplasia, requiring tracheostomy and lifelong ventilator dependence. She was admitted to the pediatric intensive care unit following cardiac arrest secondary to a tension pneumothorax and subsequently developed recurrent bronchopleural fistulas with multiple pneumothoraces requiring chest tube placement. As part of a nonsurgical management approach, multiple endobronchial valves were placed to address persistent air leaks. Conclusion Bronchopleural fistulas are abnormal connections between the bronchial tree and the pleural space, causing persistent air leaks that can complicate lung recovery, especially after lung surgeries, infections, or trauma. Treatment options are varied, and no standardized guidelines exist. This case represents the first reported use of endobronchial valves to treat persistent bronchopleural fistulas in a pediatric patient with chronic lung disease, tracheostomy, and lifelong ventilator dependence, which likely contributed to the recurrence of the bronchopleural fistulas. This case highlights the potential use of endobronchial valves as a minimally invasive alternative to surgery for pediatric patients with persistent air leaks, adding to the current growing literature. It also highlights the challenges faced in this specific pediatric patient population.