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Eur J Cardiothorac Surg 2005;28:359-360
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Kant Surgical treatment of anastomotic leaks after esophagectomy.

Richard D. Page a , * , Michael J. Shackcloth a , Glenn N. Russell b , Stephen H. Pennefather b

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

Received 27 April 2005; accepted 28 April 2005.

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

Key Words: Oesophagectomy • Anastomotic leak • Oesophageal surgery

We appreciate Dr Kant's kind comments on our report. Over the years, we have become more conservative over removing the NG tube from our patients, not just because of our concern that gastric distension may cause unwanted tension on internal suture lines, but also because of aspiration of gastric contents into the lungs. Apart from the amount of fluid aspirated from the NG tube we enquire as to the amount of air the tube produces on aspirating when taking a decision to have the tube removed. Although it is reassuring for a surgeon to have a tube in place it is always a source of discomfort for patients and may lead to impaired ability to cough.

The issue of gastric drainage and leaks after oesophagectomy has been discussed in detail by Junemann-Ramirez et al. [1]. Although, the authors felt that in their practice gastric drainage may have led to less leaks, this was not supported by a meta-analysis by Urschel [2].

We have previously studied the impact on routine enteral feeding after oesophagectomy and not found it useful [3]. Indeed, we are more concerned about the unwanted effects of jejunostomy which are avoided if a jejunostomy is not used. Our intention with early reintroduction of oral feeding is based on our overall philosophy of managing patients after oesophagectomy, which is to allow patients to return to a normal life as soon as possible after surgery.

References

  1. Junemann-Ramirez M, Awan MY, Rahamim JS. Anastomitic leakage post-esophagogastrectomy for esophageal carcinoma: retrospective analysis of predictive factors, management and influence on longterm survival in a high volume centre. Eur J Cardiothorac Surg 2005;27:3-7.[Abstract/Free Full Text]
  2. Urschel JD, Blewitt CJ, Young JE, Miller JD, Bennett WF. Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomised controlled trials. Dig Surg 2002;19:160-164.[CrossRef][Medline]
  3. Page RD, Oo AY, Russell GN, Pennefather SH. Intravenous hydration versus naso-jejunal enteral feeding after esophagectomy: a randomised study. Eur J Cardiothorac Surg 2002;22:666-672.[Abstract/Free Full Text]




This Article
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Richard D. Page
Michael J. Shackcloth
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Right arrow Esophagus - cancer
Right arrow Esophagus - other

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