Left Pleural Conduit: An Alternative Route for Esophageal Reconstruction When the Anterior and Posterior Mediastinal Planes Are Inaccessible

Restoration of gastrointestinal continuity after esophageal resection is most commonly achieved using a posterior mediastinal or retrosternal approach. In rare cases when neither plane is accessible, thoracic surgeons are faced with limited alternatives for reconstruction. We describe a case of esophagopericardial fistula after cardiac ablation that necessitated cardiac surgery and esophageal resection. With both the posterior mediastinal and retrosternal routes rendered inaccessible, we successfully constructed a gastric conduit routed through the left pleural space by using minimally invasive techniques. This report highlights the left pleural conduit as a viable alternative for esophageal reconstruction when standard approaches are not feasible.