[Protection of intrathoracic anastomosis by pleural tent methods after Ivor-Lewis esophagectomy].
OBJECTIVE
Description of a technical procedure to diminish the risk of spillage into the mediastinum in case of leakage from an intrathoracic anastomosis after partial esophagectomy.


METHODS
In Ivor-Lewis procedures for cancer of the middle or lower third of the esophagus, the esogastric anastomosis is slipped under ther upper mediastinal pleura which is kept intact. From 1989 to 1997, this technique has been used in 43 consecutive patients (squamous carcinoma in 22, adenocarcinoma in 21). Three patients died postoperatively (7%) and complications (in 38%) were mostly pulmonary and cardiac. No anastomotic leak was detected on routine Gastrografin swallow performed on the 7th postoperative day. Three patients required dilation for stenosis.


CONCLUSIONS
Subpleural blanketing of intrathoracic anastomoses after esophagectomy is safe and easy to do, and should help diminish the consequences of possible anastomotic leakage.
Clinique de chirurgie cardiovasculaire et thoracique, Hôpital Cantonal Universitaire de Genève, Suisse.
G
G
Chassot
J
J
Robert
N
N
Murith
A
A
Spiliopoulos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005402:Fistula / Q000517:prevention & control; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000601:surgery; D019616:Thoracic Surgical Procedures / Q000379:methods*