There seems to be a 'separation of the party wall'

Problem: there seems to be a ‘separation of the party wall’

A real separation of the party wall is a phenomenon that we have never seen in conjunction with the application of indwelling devices. Due to the retrograde primary or secondary insertion technique, the party wall is not at risk for separation during the surgical procedure. Furthermore, due to the fact that the first replacement is mostly only necessary after several months, by then, the party wall is stabilized and the fistula tract is well established. Therefore, if there seems to be a separation of the party wall, this is generally secondary to local infection, edema and overgrowth of esophageal mucosa (as simulated in the animation). This results in a pseudo-diverticulum as can schematically be seen in the animation. Often the prosthesis is also pushed outward and therefore seems too long (see also Problem: there are signs of local infection etc.). If this ‘separation’ is noted, the obvious solution is to insert a longer device, bridging the whole TEP tract. We have observed that by this approach the pseudo-diverticulum disappears. However, the next replacement should be carried out with even more attention than normal, in order to avoid reoccurrence of this problem.