Factors affecting leakage following esophageal anastomosis

Abstract

Esophageal anastomotic leaks remain the most serious problem following extirpative procedures for esophageal carcinoma. We conducted a retrospective analysis of 352 patients with carcinoma in the thoracic esophagus who had undergone esophageal anastomosis following esophagectomy at the Kurume University Hospital between 1981 and 1990. Of these, 94 patients (27%) developed anastomotic leaks, and out of this subgroup, 21 (6%) died as a direct result of the leak. A further 20 patients (6%) underwent repair of the leak, after which they were able to tolerate oral intake. The anastomotic leak healed spontaneously in the other 53 patients (15%). The risk factors predisposing to leaks from esophageal anastomoses were determined as: (1) the anastomosis being performed via a retrosternal or subcutaneous route as opposed to an intrathoracic route, (2) the use of colonic interposition as opposed to a gastric pedicle, (3) performing a manual anastomosis as opposed to a mechanical anastomosis, and (4) employing an end-to-end anastomosis, as opposed to an end-to-side anastomosis, using a mechanical method. By introducing an anastomotic stapling device, a microvascular technique, a staged operation based on the preoperative risk analysis, and improvement in pre- and postoperative management, the incidence of anastomotic leakage could be decreased from 35% to 14%, and that of consequent hospital mortality, from 9% to 2%.

Effectiveness of Screening Aqueous Contrast Swallow in Detecting Clinically Significant Anastomotic Leaks after Esophagectomy

“…In our study, more than half of the radiological leaks were asymptomatic. Several authors have reported similar observations [10][11][12] .…”

“…The patients were kept non per os until a second GS study, and then were allowed oral feeding even if the second GS still showed a contained leak and remained asymptomatic. Zieren et al [10] , Tilanus et al [11] and Lee et al [12] , in their series, also observed that radiological leaks remained asympto matic.…”

“…apparent leaks represented only a proportion of the total who had radiological anastomotic leaks [3,[10][11][12][13] .…”

Endoscopic Vacuum Therapy in the Treatment of Anastomotic Incompetence in the Upper Digestive Tract: The First Experience and a Review of the Literature

“…В сериях ранних сообщений, относящихся к 1990-м годам, частота не-состоятельности пищеводного анастомоза после га-стрэктомии и проксимальной резекции желудка до-стигала 30 % [2]. Публикации последних лет показывают отчетливую положительную динамику снижения частоты несостоятельности анастомоза, что является отражением безусловного прогресса хирур-гической техники и усовершенствования инструмен-тария.…”

Endoskopische Therapie von Nahtinsuffizienzen des Ösophagus

“…1) stellen eine häufige (10–30%) und gefürchtete (Mortalität 11–35%) Komplikation nach Ösophagusresektionen dar [1,2,3,4]. Der Unterdruck im Thorax begünstigt, dass infizierte Sekrete in der Speiseröhre durch die Leckage in das Mediastinum gelangen und in der Folge eine Mediastinitis verursachen können.…”