[Fistulas after Lewis-Santy's operations. Diagnosis, treatment, prevention].
Fistulas of the anastomosis is the most severe complication after the Lewis-Santy operation. Over the last 10 years, we have performed 227 such operations for cancer of the oesophagus and have observed 16 fistulizations (7%). The aim of this study was to analyze the clinical manifestations and laboratory findings in these cases of fistulization as a function of the site of the plasty, the treatment and the results. We attempted to determine factors which could lead to means of preventing this complication. The fistula occurred at the oeso-gastric anastomosis in 11 cases (4.8%), at the apex of the gastric tube in 2 and on the line of gastric tubulization in 3. A comparison between patients with fistulas (group 1) and those without (group 2) showed that 19% of the patients in group 1 were over 70 years of age versus 9% in group 2 (NS). Three of the 16 patients (19%) with fistula had cirrhosis due to ethylism versus 2 of the 211 patients in group 2 (p < 0.001). Six patients among the 58 with palliative with a fistula (6%) (NS). Thoracic drainage was sufficient in 11 patients and surgical treatment was not required. In 5 reoperation (thoracotomy 4, cervicotomy 1) was necessary due to an intrapleural abscess. After 227 Lewis-Santy operations, 11 patients died during hospitalization (4.8%, 4 of which were complicated with fistula (1.7% of the operated patients and 25% of the patients with fistulas). The frequency of fistulizations after Lewis-Santy operation has decreasing (8%) and the gravity has improved (3 out of 4 were cured).(ABSTRACT TRUNCATED AT 250 WORDS)
Lozac'h
P
P
Service de chirurgie générale et digestive, CHU Morvan, Brest.
Topart
P
P
Bail
J P
JP
Quigno
P
P
Prunier
F
F
D000230:Adenocarcinoma / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004322:Drainage; D004937:Esophageal Fistula / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery; D005747:Gastric Fistula / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D006801:Humans; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation
Les fistules après interventions de Lewis-Santy. Diagnostic, traitement, prévention.