A Method for Early Diagnosis and Treatment of Intrathoracic Esophageal Anastomotic Leakage: Prophylactic Placement of a Drainage Tube Adjacent to the Anastomosis

Tang, Hua; Xue, Lijun; Jiang, Hong; Tao, Xiandong; Xu, Zhifei; Wu, Bin

doi:10.1007/s11605-011-1788-z

Cited by 27 publications

(28 citation statements)

References 15 publications

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“…Treatment of fistula and anastomotic leak without symptoms of mediastinitis and Sepsis is conservative containing the appropriate antibiotic through feeding tube into the esophagus (17). For discharge drainage, if there is not enough drain, it will be possible to insert extra drain for better drainage (18). If the discharge is relatively high, and there is no tissue necrosis in esophagus and anastomosis region, proper drainage will be mandatory and sutured mesh and fibrin glue can be used in some appropriate conditions (19).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Mousavi¹,

Akbari²

2017

Int J Cancer Manag

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Background: Due to the high prevalence and mortality rates of esophageal cancer in some parts of the world and considering that in most patients, symptoms occur when cancer is advanced, this study aimed to compare early and late complications in three esophagectomy techniques for treatment of esophageal cancer. Methods: The present study was a descriptive research on 316 patients with esophageal cancer referring to Shohada Tajrish hospital, Tehran. The results were recorded in the research forms consisting of individual characteristics, symptoms and reasons for referring to the hospital. Findings were extracted after classification and evaluated using descriptive statistics. Results: Among 316 patients studied, 190 patients (60%) were male and 126 (40%) were female. The highest prevalence was between 40 and 60 years old. The most significant reason for referring to the hospital was dysphagia and weight loss. Among 260 patients, 72 patients (27.7%) underwent surgery by transthoracic (Ivor Lewis type) approach, 76 patients (29.2%) underwent surgery by threeincision approach (Mc Keown procedure), and 112 patients (43%) underwent surgery by Trans-Hiatal (Oringer). A total of 36 deaths occurred. 22 deaths occurred using Ivor-Lewis (61%), 10 deaths occurred using Mc Keown (27.7%) and 4 deaths occurred after Oringer (11.1%). In terms of prevalence of complications, the most common early complication was pleural effusion (11%) and the most common late complication was anastomotic stricture (17.8%). Conclusions:Complications occurred in all three surgeries. The most complications occurred using transthoracic (Ivor Lewis type) approach and the least complications occurred using Trans-Hiatal (Oringer).

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Section: Discussionmentioning

confidence: 99%

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Mousavi¹,

Akbari²

2017

Int J Cancer Manag

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“…Resolution of anastomotic leak was significantly faster in the prophylactic drain group (mean 23.4 vs 80.7 days; p<0.05) as was return to oral intake (mean 32.2 vs 98 days). [10] Perianastomotic drain placement permitted bedside assessment for leak using methylene blue and minimized the time delay in diagnosis that accompanies radiographic imaging. Use of drain amylase levels for confirmation of leak may be another advantage of perianastomotic drain placement, but only one abstract (not published in manuscript form) was identified in the systematic review.…”

Section: Prophylactic Management Of Anastomotic Leak After Esophagectmentioning

confidence: 99%

Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review

Schaheen

Blackmon

Nason

2014

The American Journal of Surgery

101

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Background Recently, endoscopic interventions, e.g. esophageal stenting, have been successfully utilized for the management of intrathoracic leak. The purpose of this systematic review was to assess the safety and efficacy of techniques used in the management of intrathoracic anastomotic leak. Data Sources We performed a systematic review of MEDLINE, EMBASE, and PubMed to identify eligible studies analyzing management of intrathoracic esophageal leak following esophagectomy. Conclusions Intraoperative anastomotic drain placement was associated with earlier identification and resolution of anastomotic leak (mean 23.4 vs 80.7 days). In addition, reinforcement of the anastomosis with omentoplasty may reduce the incidence of anastomotic leak by nearly 50%. Endoscopic stent placement was associated with leak resolution in 72%; fatal complications were reported, however, and safety remains to be proven. Negative pressure therapy, a potentially useful tool, requires further study. If stenting and wound vacuum are used, undrained mediastinal contamination and persistent leak requires surgical intervention.

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“…Patients with small and sufficiently drained fistulas (Fig 2a) that show neither signs of mediastinitis nor sepsis can be treated conservatively by antibiotics and enteral nutrition via an esophageal feeding tube 37 . In any event, sufficient drainage of the leak is paramount and is usually achieved by drains placed during the operation 38 . Should these drains prove inefficient at draining the leaks, new drains must be placed.…”

Section: Therapeutic Optionsmentioning

confidence: 99%

“…37 In any event, sufficient drainage of the leak is paramount and is usually achieved by drains placed during the operation. 38 Should these drains prove inefficient at draining the leaks, new drains must be placed. Total parenteral nutrition can be considered if the placement of a nasogastric feeding tube is deemed inappropriate (e.g.…”

Section: First Degreementioning

confidence: 99%

Current concepts in the management of leakages after esophagectomy

2012

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Esophagectomy is a high-risk procedure that, despite advances over past years, is still associated with high morbidity and mortality. Anastomotic insufficiency is a devastating surgical complication as it is linked to postoperative morbidity and is the main cause for postoperative mortality. It can lead to sepsis and necessitate re-operation, further increasing morbidity and mortality through additional complications brought on by the repeated invasive procedures. However, not all anastomotic leakages entail such a critical course of events and can be sufficiently dealt with by less invasive measures. As a consequence, the approach to anastomotic leakage must be carefully selected in order to minimize additional procedure-related risks while ensuring adequate therapy. In this setting, less invasive treatments such as esophageal stents and clips, application of vicryl plugs in combination with fibrin glue, and endoscopic insertion of vacuum sponges, have emerged in recent years and become a viable alternative in the management of certain leakages. This review presents current algorithms for detection, classification and treatment of leakages after esophagectomy.

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A Method for Early Diagnosis and Treatment of Intrathoracic Esophageal Anastomotic Leakage: Prophylactic Placement of a Drainage Tube Adjacent to the Anastomosis

Abstract: In conclusion, prophylactic implantation of a drainage tube adjacent to the esophageal anastomosis is a good method for rapid diagnosis and treatment of leakage.

Cited by 27 publications

References 15 publications

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Comparison of Early and Late Complications in Three Esophagectomy Techniques

Optimal approach to the management of intrathoracic esophageal leak following esophagectomy: a systematic review

Current concepts in the management of leakages after esophagectomy

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