Anastomotic Leakage after Upper Gastrointestinal Surgery: Surgical Treatment

Abstract

Background: Anastomotic leakage after upper gastrointestinal surgery is associated with major morbidity and mortality. In recent years, there was a major paradigm shift in the management of leakage after upper gastrointestinal surgery from surgical towards conservative and endoscopic treatment approaches as first-line treatment options. Methods: We conducted a PubMed literature search using combinations of the keywords ‘leakage', ‘complication', ‘esophagectomy', ‘gastrectomy', and ‘pancreatectomy' to identify relevant publications. Results: Surgical re-intervention after esophagectomy, gastrectomy, or pancreatectomy is still indicated in selected patients, depending on the severity of symptoms, the condition of the patient, and failure of initiated treatment. Furthermore, surgical revision after esophagectomy and gastrectomy is indicated for early leakage and depends on the extent of anastomotic disruption and the condition of tissue. Conclusion: Surgical re-intervention still plays a crucial role in the management of leakage after upper gastrointestinal surgery, especially in critically ill patients and after failure of conservative or endoscopic treatment.

A Unique Presentation of Bouveret’s Syndrome: Two Large Gallstones Obstructing Both the Gastric Outlet and the Common Bile Duct Simultaneously

“…In general, if patients present with contained leak and are relatively asymptomatic, medical or interventional treatment can usually successfully address the leak. Surgical management is only considered when patient is critically ill (with sepsis, peritonitis, and acidosis) with an uncontained leak or has failed medical and interventional management [ 15 ].…”

Change from Hybrid to Fully Minimally Invasive and Robotic Esophagectomy is Possible without Compromises

“…17 Nonetheless, 5-year survival rates range between 15 and 25%, with more studies underlying the beneficial outcome of early stage tumor diagnosis and treatment. 18,19 In addition to the severity of tumor is the severity of the operation, with anastomotic leakage rates from 2 to 35% [20][21][22][23] and mortality rates exceeding 20% in small-volume centers. 24 Several studies highlight the fact that the Ivor Lewis procedure is the preferable minimally invasive technique.…”

Esophageal cancer surgery: review of complications and their management

“…The cervical wound will develop an erythema, induration, or fluctuance. 17 The appearance of saliva or air in the surgical drain should raise suspicion of a leakage. Even if cervical anastomosis is at higher risk for leakage, its consequence is different.…”

“…The diagnosis of cervical anastomotic leakage can be clinical. The cervical wound will develop an erythema, induration, or fluctuance 17 . The appearance of saliva or air in the surgical drain should raise suspicion of a leakage.…”