Successful Salvage of Partial Gastric Conduit Necrosis by Primary Anastomosis in a Post-Esophagectomy Patient

Gastric conduit necrosis is a rare but severe complication of esophageal surgery, often associated with mediastinal sepsis and high morbidity and mortality rates, as well as reduced efficacy of conservative treatments. In most cases, management involves salvage therapy, including fluid resuscitation, antibiotics, aggressive debridement, drainage of infected collections, and proximal esophageal diversion. Primary anastomosis is rarely performed. We describe a successful case wherein we salvaged a patient following a McKeown esophagectomy and gastric pull-up, who developed partial full-thickness necrosis of the gastric conduit postoperatively, along with pleural and mediastinal sepsis. We managed this situation through thoracic debridement, take-down of the anastomosis, resection of the devitalized segment of the conduit, and primary esophagogastric anastomosis. Conduit perfusion was demonstrated using ICG fluorescent angiography. This case illustrates that, once debridement and sepsis control are achieved, a primary anastomosis, if feasible, can be safely performed, potentially avoiding a two-step procedure and a second laparotomy/thoracotomy.