Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma.
OBJECTIVE
The management of anastomotic leakage of the oesophago-jejunostomy after total gastrectomy for gastric carcinoma was evaluated in a retrospective study.


METHODS
Over a 30-year period, a total of 1114 oesophago-jejunostomies were performed during total gastrectomy for gastric cancer. In 83 cases (7.5%) a leak of the oesophago-jejunostomy was diagnosed.


RESULTS
Frequency of anastomotic leakage was independent of the type of reconstruction and of surgical radicality. Therapeutic management was conservative in 58 cases (69.9%), with placement of a naso-jejunal tube along the anastomoses and with percutaneous drainage of intraabdominal abscesses. In 25 patients re-operation with resuturing of the anastomoses or surgical drainage of an abscess was performed. Mortality was 11/58 (19%) after conservative treatment of the anastomotic leakage and 16/25 (64%) after re-operation.


CONCLUSIONS
Conservative management with a naso-intestinal tube and percutaneous drainage of intraabdominal abscesses is realistic for anastomotic leaks. Re-operation results in a high morbidity and should only be considered when conservative management is not successful.
Lang
H
H
Klinik für Abdominal- und Transplantationschirurgie, Medizinische Hochschule Hannover, Hannover, Germany.
Piso
P
P
Stukenborg
C
C
Raab
R
R
Jähne
J
J
D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D002277:Carcinoma / Q000601:surgery*; D013505:Digestive System Surgical Procedures; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007583:Jejunum / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D015996:Survival Rate