Surgical treatment of anastomotic leaks after oesophagectomy

Page, Richard; Shackcloth, Michael; Russell, G. N.; Pennefather, Stephen H.

doi:10.1016/j.ejcts.2004.10.053

Cited by 92 publications

(60 citation statements)

References 18 publications

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“…We recorded four relevant clinical signs to predict anastomotic leakage, including the signs of systemic inflammatory response syndrome (SIRS), leukocytosis, defined as a leukocyte count !20 Â 10 9 /ml, fever defined as temperature !39.08C, pleural effusion, defined as increased pleural fluid postoperatively, and sepsis [10]. Because leukocytosis (leukocyte count >10 Â 10 9 /ml) and a rise in temperature commonly appear after major surgery, a leukocyte count !20 Â 10 9 /ml and a temperature !39.08C were taken as the cut-off points [11].…”

Section: Clinical Symptomsmentioning

confidence: 99%

Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy

Honing

Pultrum

Jagt

et al. 2009

Journal of Surgical Oncology

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Section: Clinical Symptomsmentioning

confidence: 99%

Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy

Honing

Pultrum

Jagt

et al. 2009

Journal of Surgical Oncology

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“…The constant leakage of gastric juices and saliva into the pleural and mediastinal cavities make this a life-threatening condition responsible for 40% of postoperative mortality (14). The incidence of leak with an intrathoracic anastomosis reported in the literature varies between 3% and 25%, even though published guidelines recommend that the incidence of anastomotic leak should not exceed 5% (15).…”

Section: Discussionmentioning

confidence: 99%

“…All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, 10 days [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] vs. 48 days , p = 0.228 and 12 days [8][9][10][11][12][13][14][15][16][17][18][19][20][21] vs. 20 days , p = 0.374) (Fig. 1).…”

Section: Sems Placement and Adverse Eventsmentioning

confidence: 99%

Self-expanding metal stents in postoperative esophageal leaks

Rodrigues‐Pinto¹,

Pereira²,

Ribeiro³

et al. 2016

Rev Esp Enferm Dig

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Background: Postoperative esophageal leaks have a high morbidity and mortality. Self-expanding metal stents (SEMS) have been used as an alternative to re-operation.Aim: Evaluating predictors of success of SEMS in postoperative esophageal leaks.Methods: Retrospective study of patients with postoperative esophageal leaks referred for SEMS placement in a reference center during a period of 3 years. Technical success was defined as closure of the leak in barium swallow at 15 days. Clinical success was considered as endoscopic and/or radiographic confirmation of closure after stent removal.Results: Thirteen patients placed SEMS. Median follow-up was 58 days. Leaks had a median size of 20 mm. Time between surgery and SEMS placement was 20 days. One patient died 2 days after SEMS placement and one had worsening of the fistula after SEMS expansion. Time till stent migration was 9 days. Technical success was achieved in 9 of 11 patients, with clinical success without recurrence in 5 patients. All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, p = 0.228 and 0.374). In the 8 patients who died during follow-up, median survival was 59 days.Conclusions: Technical success of SEMS was higher than 80%; however, due to high morbidity and mortality, only 45% of patients had their stent removed. Lower time from diagnosis to SEMS placement and leak size less than 20 mm may be associated with better results.

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“…Beide Faktoren sind für die Einleitung einer adäquaten Therapie essenziell [32,33]. Entscheidend für die Auswahl des optimalen Behandlungsverfahrens ist die bestehende Symptomatik, der Zeitpunkt nach der Operation, die Lokalisation und Größe der Anastomoseninsuffizienz, die Durchblutungssituation sowie der Anschluss der Insuffizienz an noch liegende Drainagen [4,5,34]. …”

Section: Therapie Bei Anastomoseninsuffizienzen Nach öSophagus- Und Munclassified

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

Werner¹,

Sauer

2013

Visc Med

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Hintergrund: Anastomoseninsuffizienzen stellen die schwerwiegendste septische Komplikation nach viszeralchirurgischen Eingriffen dar. Neben der chirurgischen Therapie sind zunehmend endoskopische Behandlungsoptionen möglich. Methode: Literaturübersicht. Ergebnisse: Therapieoptionen von Anastomoseninsuffizienzen sind abhängig von der klinischen Symptomatik, der Art der Anastomose, der Defektgröße, den lokalen Gewebeverhältnissen sowie dem Zeitpunkt der Diagnose. Bei einer Nekrose oder Minderdurchblutung der Viszeralorgane müssen diese operativ reseziert werden. Prinzipiell sind alle operativen Revisionseingriffe auch laparoskopisch durchführbar. Bei erhaltener Gewebeperfusion können die Leckagen lokal übernäht oder endoskopisch verschlossen werden. Die Ergebnisse für die Stenttherapie nach Ösophagus- und Magenresektionen sind für moderne Stents sehr Erfolg versprechend. Im Gegensatz dazu sind die Ergebnisse der endoskopischen Stenttherapie bei Insuffizienz nach kolorektalen Eingriffen enttäuschend; dafür steht hier mit der Schwammtherapie eine vielversprechende endoskopische Alternative zur Verfügung. Schlussfolgerung: Die aktuellen Daten zeigen, dass neue laparoskopische und endoskopische Optionen zur Therapie von Anastomoseninsuffizienzen bestehen, die jedoch noch in prospektiven und randomisierten Studien evaluiert werden müssen.

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Surgical treatment of anastomotic leaks after oesophagectomy

Cited by 92 publications

References 18 publications

Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy

Routine or on demand radiological contrast examination in the diagnosis of anastomotic leakage after esophagectomy

Self-expanding metal stents in postoperative esophageal leaks

Nahtinsuffizienz intestinaler Anastomosen: Endoskopische und laparoskopische Therapieoptionen

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