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.
Enteral feeding via a naso-jejunal tube is safe and well tolerated after esophagectomy. It is a simple method of providing nutritional support prior to the re-introduction of oral feeding. However it provides no measurable benefit over intravenous hydration only for patients undergoing routine esophagectomy.
Ipsilateral shoulder pain after thoracotomy is common and may be severe, even in the presence of a functioning thoracic epidural. We have shown that infiltration of the phrenic nerve with local anesthetic significantly and safely reduces this shoulder pain, potentially allowing the ideal goal of a pain-free thoracotomy.
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