HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Richard D. Page Michael J. Shackcloth Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Page, R. D. Articles by Pennefather, S. H. Search for Related Content PubMed PubMed Citation Articles by Page, R. D. Articles by Pennefather, S. H. Related Collections Esophagus - other

Eur J Cardiothorac Surg 2005;27:337-343
© 2005 Elsevier Science NL

Surgical treatment of anastomotic leaks after oesophagectomy

^a Department of Thoracic Surgery, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK
^b Department of Anaesthesia, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK

Received 22 July 2004; received in revised form 19 October 2004; accepted 25 October 2004.

^* Corresponding author. Tel.: +44 151 293 2456; fax: +44 151 220 8573. (E-mail: richard.page{at}ctc.nhs.uk).

Objective: To determine the optimum management of anastomotic leaks after oesophagectomy. Methods: We undertook a retrospective review of 23 patients who developed anastomotic leakage, out of 389 patients undergoing oesophagectomy with gastric interposition. The presentation, diagnosis, and treatment of the leaks, and patient outcomes are analysed. Results: Leaks occurred from 3 to 23 (median=7.5) days after surgery. Clinical features included fever (57%), leucocytosis (52%), dysphagia (4%), coughing bile (4%), wound infection (13%), pneumothorax (35%), pleural effusion (70%) and septicaemia (70%). All but one leak was due to variable degree of gastric tip necrosis. Contrast swallow showed leakage in only 14 (61%) patients, whereas oesophagoscopy confirmed all the leaks. Surgical treatment (resection of necrotic stomach and either immediate or staged re-anastomosis, or end-oesophageal exteriorisation) was the primary treatment in 17 patients of whom 15 survived to discharge. Two out of the 6 patients treated non-surgically died. Conclusions: Diagnosis of anastomotic leakage after oesophagectomy is difficult due to its variable presentation and the unreliability of contrast swallow. Gastric tip necrosis is by far the most common cause. We feel our preferred strategy of immediate surgical treatment of symptomatic leaks is justified by the favourable outcome in the majority of patients.

Key Words: Oesophagectomy • Anastomotic leak • Oesophageal surgery

This article has been cited by other articles:

				C. Zisis, A. Guillin, L. Heyries, P. Lienne, X.-B. D'Journo, C. Doddoli, R. Giudicelli, and P.-A. Thomas Stent placement in the management of oesophageal leaks Eur. J. Cardiothorac. Surg., March 1, 2008; 33(3): 451 - 456. [Abstract] [Full Text] [PDF]

				O. Y. Al-Rawi, S. H. Pennefather, R. D. Page, I. Dave, and G. N. Russell The Effect of Thoracic Epidural Bupivacaine and an Intravenous Adrenaline Infusion on Gastric Tube Blood Flow During Esophagectomy Anesth. Analg., March 1, 2008; 106(3): 884 - 887. [Abstract] [Full Text] [PDF]

				X.-W. Han, Y.-D. Li, G. Wu, M.-H. Li, and X.-X. Ma New Covered Mushroom-Shaped Metallic Stent for Managing Anastomotic Leak After Esophagogastrostomy With a Wide Gastric Tube Ann. Thorac. Surg., August 1, 2006; 82(2): 702 - 706. [Abstract] [Full Text] [PDF]

				S. Kant Gastric tip necrosis Eur. J. Cardiothorac. Surg., August 1, 2005; 28(2): 359 - 359. [Full Text] [PDF]