Update on therapeutic strategy for esophageal anastomotic leak: A systematic literature review

Abstract

Anastomotic leak is still a severe complication in esophageal surgery due to high mortality. This article reviews the updates on the treatment of anastomotic leak after esophagectomy in order to provide reference for clinical treatment and research. The relevant studies published in the Chinese Zhiwang, Wanfang, and MEDLINE databases to December 21, 2021 were retrieved, and esophageal carcinoma, esophagectomy, anastomotic leakage, and fistula selected as the keywords. A total of 78 studies were finally included. The treatments include traditional surgical drainage, new reverse drainage trans-fistula, stent plugging, endoscopic clamping, biological protein glue injection plugging, endoluminal vacuum therapy (EVT), and reoperation, etc. Early diagnosis, accurate classification and optimal treatment can promote the rapid healing of anastomotic leaks. EVT may be the most valuable approach, simultaneously with good commercial prospects. Reoperation should be considered in patients with complex fistula in which conservative treatment is insufficient or has failed.

Safety of omitting nasogastric decompression after esophagectomy: a propensity score-matched study

“…Our management strategies for anastomotic leak were consistent with those previously reported ( 10 , 11 ). They could be sorted into three levels: conservative management, endoscopic intervention, and reoperation, and which treatment would be performed depended on the symptoms and surgeons’ experience.…”

Re-thoracoscopy for the management of gastric conduit dehiscence after minimally invasive McKeown esophagectomy

“…Gastric conduit failure, as well as anastomotic leak, leads to lethal consequences for the patient, such as mediastinal abscesses and pleural empyema up to complex complications such as bronchial-pulmonary fistula or macrovascular fistula; treatments include traditional surgical drainage, drainage trans-fistula, stent plugging, endoscopic clamping, biological protein glue injection plugging, endoluminal vacuum therapy and reoperation [7] .…”

Technik der Koloninterposition zum Ösophagusersatz beim Ösophaguskarzinom

“…In dieser Indikationsgruppe werden, aufgrund des i. d. R. zweizeitigen Vorgehens zervikale Anastomosen notwendig, da bei der primären Komplikationsbehandlung in oft septischen Situationen eine komplette thorakale Ösophagusresektion durchgeführt wird und eine passagere zervikale Ösophagusfistel angelegt wird. Insgesamt wird diese Indikationsgruppe allerdings zunehmend kleiner, da sowohl Anastomoseninsuffizienzen als auch Magenschlauchischämien heute in der Mehrzahl der Fälle organerhaltend mit endoskopisch-interventionellen Techniken der Vakuumdrainage oder Ösophagusstenttherapie suffizient und organerhaltend beherrscht werden können [9,10]. In der publizieren Fallserie wurden sehr gute funktionelle Ergebnisse ohne relevante Dysphagie beschrieben [7].…”