Transhiatal Chest Drainage After Oesophagectomy

Gogălniceanu, Petruţ; Crewdson, Kate; Aa, Khan; Botha, Abrie

doi:10.1308/rcsann.2007.89.5.535

Cited by 8 publications

(7 citation statements)

References 6 publications

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“…Chest drain tubes can be placed through the diaphragmatic hiatus and exit abdominally. 35 Interestingly, one patient in this series with Boerhaave's Syndrome who underwent successful operative repair represented with an episode of vomiting 8 months later and was diagnosed with a recurrent rupture of the distal esophagus. Recurrent esophageal perforations have been reported before.…”

Section: Discussionmentioning

confidence: 81%

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Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK

Griffiths

Yap

Poulter

et al. 2009

Diseases of the Esophagus

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Esophageal perforation is uncommon and traditionally has a high rate of morbidity and mortality. Our aim was to perform a 13-year retrospective review of the cases managed in our district general hospital. Thirty-four cases of esophageal perforation diagnosed between 1995 and 2008 were retrospectively analyzed. There were 20 males and 14 females with a median age of 64 (range 23-86) years. The etiology of the perforations were Boerhaave's syndrome (n= 19), therapeutic endoscopy (n= 9), diagnostic endoscopy (n= 2), gastric lavage injury (n= 1), foreign body (n= 1), blunt chest trauma (n= 1), and spontaneous tumor perforation (n= 1). Only 11 cases (32%) had evidence of surgical emphysema upon examination. In 50% of cases, another clinical diagnosis was initially suspected. Twenty-four were treated surgically and 10 cases managed non-operatively. Surgical treatment included thoracotomy with primary repair (n= 9), T-tube drainage (n= 7), emergency esophagectomy (n= 1), or intra-operative stent insertion (n= 1). Four cases had primary repair and fundal wrap via abdominal approach without thoracotomy. Two patients were treated with washout and drainage only. Eight patients died overall (in-hospital mortality 23.5%). Esophageal perforations are often initially misdiagnosed and the majority do not have surgical emphysema. There are a wide variety of methods to manage esophageal perforation. Management tailored to the location and size of perforation, degree of contamination, and underlying cause appears to result in a reasonable prognosis.

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Section: Discussionmentioning

confidence: 81%

“…This approach is only indicated in lower esophageal perforations where the perforation can be visualized trans‐hiatally, and adequate mediastinal washout can be achieved through both pleural cavities. Chest drain tubes can be placed through the diaphragmatic hiatus and exit abdominally 35 …”

Section: Discussionmentioning

confidence: 99%

Thirty-four cases of esophageal perforation: the experience of a district general hospital in the UK

Griffiths

Yap

Poulter

et al. 2009

Diseases of the Esophagus

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“…Left and right transhiatal chest drains were introduced under direct vision through the abdominal port sites. 9 For the thoracic phase, the patient was in the left lateral position for a posterolateral thoracotomy incision. In the case of the VATS procedures, two or three 12mm thoracoscopic ports were inserted, allowing the thoracotomy incision length to be reduced to 10-15cm with sparing of the latissimus dorsi and serratus anterior muscles.…”

Section: Operative Techniquementioning

confidence: 99%

“…Another suggestion has been the performance of extracorporeal gastric tube formation through a mini-laparoto- 9 This may mean that the benefit of reduced perioperative pain with minimally invasive surgery is lost and it may also impact adversely on the respiratory complication rate.…”

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confidence: 99%

Gastric tube necrosis following minimally invasive oesophagectomy is a learning curve issue

Ramage

Deguara

Davies

et al. 2013

annals

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Introduction Gastric tube necrosis following oesophagectomy is thought to have an increased association with a minimally invasive technique. Some suggest gastric ischaemic preconditioning may reduce ischaemic complications. We discuss our series of 155 consecutive minimally invasive oesophagectomies (MIOs), including a number of cases of gastric tube ischaemia, of which 4 (2.6%) developed conduit necrosis. Methods Data were collected prospectively of MIOs carried out by a single surgeon between 2005 and 2011. Cases of gastric tube necrosis were identified. Results Overall, 155 patients were identified. The inpatient mortality rate was 2.6%. Gastric tube necrosis occurred in four patients (2.6%). An ultrasonic dissector injury to the gastroepiploic arcade had occurred in two cases. In another case, the gastric tube was strangulated in the hiatus. In the remaining case, no clear mechanical cause was identified. All 4 cases occurred within the first 73 cases. The gastric tube necrosis rate of the first 50 cases versus cases 51–155 was 4% and 2% respectively (p=0.5948). The anastomotic leak rate in these two cohorts was 18% and 7% respectively (p=0.0457). There was a significant reduction in overall gastric tube complications from 22% to 10% following the learning curve of the initial 50 cases (p=0.0447). Conclusions In our series, gastric tube necrosis appears to be a learning curve issue. Prophylactic measures such as ischaemic preconditioning become less relevant as the operating surgeon’s experience increases. Instead, meticulous attention to preserving the gastroepiploic arcade, avoidance of tension in the tube and careful positioning of the gastric conduit through an adequately sized hiatus are key factors.

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“…109 110 and removal irrespective of volume in thoracoscopy (albeit underpowered) (Table 11). 116,117 Mobile vacuum chest drains have also been reported as feasible in 80% of esophagectomies. Traditionally, apical and basal drains are used ipsilaterally-with or without a contralateral drainalthough many surgeons use just 1 drain (Table 12).…”

Section: Chest Drainsmentioning

confidence: 99%