Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses

Hoeppner, Jens; Kulemann, Birte; Seifert, Garbriel; Marjanović, Goran; Fischer, Andreas; Hopt, Ulrich T.; Richter-Schrag, Hans-Jürgen

doi:10.1007/s00464-013-3379-4

Cited by 54 publications

(45 citation statements)

References 31 publications

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“…Anastomotic leakage ratios are 3-25% for esophageal surgery and 5-8% for gastric surgery [11,12]. The mortality rate is extremely high for redoing gastrointestinal surgery.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic approach to anastomotic leaks: partially covered self-expandable stents. A single center’s experience

Aday¹,

Duman²,

Deđer³

et al. 2017

Arch Med Sci Civil Dis

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A b s t r a c tIntroduction: Anastomotic leakage is an important and undesirable major complication after upper and lower gastrointestinal surgery. This complication can lead to significant morbidity and mortality and prolonged hospital stay. The objective of this study was to evaluate the safety and technical and clinical outcomes of temporary partially covered self-expandable metallic stent (PCSEMS) placement for treating anastomotic leaks after gastrointestinal tract surgery. Material and methods: Medical records of 9 patients who had undergone partial covered self-expandable esophageal or colonic stenting either for colorectal anastomotic leak or esophageal anastomotic leak in Kartal Kosuyolu Higher Specialty Training and Research Hospital between April 2012 and October 2015 were collected. Living patients were recalled for the policlinic follow-up and recent status was recorded. Results: The mean age was 57 (37-78) years. Six of the patients were male and 3 of them female. Stents were successfully placed in all patients in the fistula localization on the first attempt. Stent migration was encountered in 3 patients and restenting was performed in 2 of these patients. No complications were seen related to the indwelling stents. Stent treatment failure occurred in 2 of the 9 patients. The mean removal time of the stent was 43 (5-70) days and it was not possible to get the stent out in 1 patient. Conclusions: Endoscopic stenting is a minimally invasive and highly effective procedure that gives promise for the treatment of fistula after digestive surgery in the future.

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“…Anastomotic leakage ratios are 3-25% for esophageal surgery and 5-8% for gastric surgery [11,12]. The mortality rate is extremely high for redoing gastrointestinal surgery.…”

Section: Discussionmentioning

confidence: 99%

“…For this reason self-expandable metallic stent utilization receives more attention every day. It has been reported that the endoscopic stent success rate is 40-80% [11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic approach to anastomotic leaks: partially covered self-expandable stents. A single center’s experience

Aday¹,

Duman²,

Deđer³

et al. 2017

Arch Med Sci Civil Dis

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“…[3,4] The best results can be achieved in leaks occurring after the very early postoperative phase with a covered self-expanding stent. [5] In delayed leaks, the decision is radiological drainage or surgical re-exploration. [3] Abdominal sepsis is the host's systemic inflammatory response to bacterial or yeast peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Treatment with vacuum assisted closure system: A case with anastomotic leak after the upper gastrointestinal surgery

Eğin¹

2018

Ulus Travma Acil Cerrahi Derg

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Presently described is a case treated via stent and vacuum-assisted closure (VAC). The patient developed an oesophagojejunostomy leak (OL) on the ninth postoperative day after a radical total gastrectomy. The patient was a 55-year-old male patient with adenocarcinoma localized to the small curvature on the corpus of the stomach. Relaparatomy was performed for the OL, including placement of an uncovered stent. The abdomen was washed 4 times. As the OL did not decrease, 2 covered stents (22 mm and 18 mm in diameter and 80 mm long) were inserted endoscopically. The OL continued to contaminate the abdomen. One tip of the VAC sponge was placed next to the anastomosis, and the other tip was removed from the left upper quadrant. Another VAC closure set was placed in the abdomen. Both VAC closures were connected to separate vacuum devices with 75 mmHg of pressure. VAC dressings were changed at regular intervals every 3 days, and these steps were repeated 7 times over 21 days. The covered stents were removed endoscopically in the final operation. Fistulography revealed that the OL was completely closed, and the VAC dressings were removed. The skin was closed by separating the subcutaneous oil layer of the fascia. VAC therapy can not only provide serious abdominal sepsis treatment and primary source control, but also accelerate granulation development and, in this case, quickly closed the anastomotic leakage.

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“…Die Erfolgsraten dieser Behandlung, sei es über eine Therapie mit Stent und Drainagemanagement oder eine Endo-VAC-Behandlung, liegen zwischen 70 und 100 %, woraus sich eine Rate von ungefähr 90 % erfolgreich therapierten Patienten ergibt [11,13,14]. Die Erfolgsrate der Endo-VAC-Behandlung liegt dabei etwas höher als bei alleiniger Stenttherapie.…”

Section: Diskussionunclassified

“…In unserer Kohorte kam es zu keiner Stentmigration, wohingegen die Rate der Stentmigration bei Ösophagusstents mit bis zu 30 % beschrieben wird [16]. Auch in aktuellen Arbeiten wird die Rate der Stentdislokation mit 25 % angegeben [13].…”

Section: Diskussionunclassified

Interdisziplinäres Management bei Anastomoseninsuffizienz nach Ösophagusresektion zur Vermeidung der Ösophagektomie

Herrmann¹,

Mahoozi²,

Kemen

et al. 2019

Zentralbl Chir

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Zusammenfassung Hintergrund Die Anastomoseninsuffizienz nach Ösophagusresektion ist eine schwere Komplikation und mit einer hohen Letalität assoziiert. Ein konservatives Vorgehen, mittels Stentimplantation oder Endo-VAC-Therapie stellt den initialen Therapieansatz dar. Diese Arbeit beschreibt eine Kombination aus konservativem und chirurgischem Management nach einem frustranen initialen Therapieversuch zur Vermeidung einer Ösophagektomie. Material und Methoden Es wurden alle Patienten eingeschlossen, die zwischen Mai 2008 und Dezember 2016 aufgrund einer Anastomoseninsuffizienz nach Ösophagusresektion in unserer Klinik für Thoraxchirurgie behandelt wurden. Nach initialem Therapieversagen erhielten die Patienten eine konservativ-chirurgische Kombinationstherapie. Ein Ösophagusstent wurde implantiert und mittels transmuraler, resorbierbarer Naht fixiert. Nachfolgend wurde ein radikales mediastinales und pleurales Débridement durchgeführt und der Defekt mittels Muskellappenplastik gedeckt. Bei postoperativem Keimnachweis wurde zusätzlich eine diskontinuierliche Spültherapie der Pleurahöhle durchgeführt. Wir analysierten die Faktoren, die einen Einfluss auf die Letalität nach Therapie einer Anastomoseninsuffizienz nach Ösophagusresektion hatten. Ergebnisse 18 Patienten wurden nach erfolgloser konservativer Therapie einer Anastomoseninsuffizienz nach Ösophagusresektion in unserer Klinik vorgestellt. 15 Patienten wurden innerhalb von 20 Tagen nach Detektion der Anastomoseninsuffizienz überwiesen, 3 Fälle mehr als 20 Tage nach Auftreten erster Symptome einer Anastomoseninsuffizienz. Alle Patienten präsentierten sich mit einem rechtsseitigen Pleuraempyem, Pneumonie, Mediastinitis und Sepsis. In 3 Fällen lag ein beidseitiges Pleuraempyem vor. Die erfolgreiche chirurgische Therapie der Anastomoseninsuffizienz gelang in 100% der Fälle. Die 90-Tages-Mortalität lag bei 20% (3 Patienten). Zusammenfassung Insgesamt hat das kombinierte Management der Anastomoseninsuffizienz nach Ösophagusresektion eine sehr hohe Erfolgsrate. Einzig das Fortführen einer konservativen Therapie für mehr als 20 Tage hat einen signifikanten Einfluss auf die Letalität.

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Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses

Cited by 54 publications

References 31 publications

Endoscopic approach to anastomotic leaks: partially covered self-expandable stents. A single center’s experience

Endoscopic approach to anastomotic leaks: partially covered self-expandable stents. A single center’s experience

Treatment with vacuum assisted closure system: A case with anastomotic leak after the upper gastrointestinal surgery

Interdisziplinäres Management bei Anastomoseninsuffizienz nach Ösophagusresektion zur Vermeidung der Ösophagektomie

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