Trans-oral irrigation for the management of cervical esophagogastric anastomotic leak.
Over a period of 8 years, 15 of the 65 patients who had transhiatal esophagectomy (THE) for esophageal diseases and cervical esophagogastrostomy had cervical oesophagogastric anastomotic leak. Seven of the 18 patients (38.9%) with corrosive esophageal strictures (CES) due to acid burns had anastomotic leaks while 2 out of 6 patients (33.3%) and 6 out of 41 patients (14.6%) were the incidences of anastomotic leaks among alkali burnt and carcinoma of the esophagus. Anastomotic leaks were more commonly associated with surgery for CES. They were managed by trans-oral irrigation with water after ingestion of either soft/solid diet or high protein, high carbohydrate fluid diet along with adequate jejunostomy feeding. The age of the patients ranged between 5 to 65 years (mean 38.8 +/- 15.7 year). Anastomotic leaks were diagnosed between 3rd to 10th postoperative day (mean 7.1 +/- 2.6 day). The period of transoral irrigation before closure of leakage ranged from 2 to 14 days (mean 6.1 +/- 2.9). In 12 patients (80%) anastomotic leakage closed within 5 days, (mean 3.9 +/- 1.0). Two weeks after closure, all the patients had bouginage and every two weeks for another 3 dilation. Four of the 15 patients needed repeated two monthly dilation for 8 to 12 months. There were no other complications nor mortality in this study. There was psychological acceptance of this minimally invasive procedure.
Adegboye
V O
VO
Department of Surgery, University College Hospital, Ibadan, Nigeria.
Brimmo
I A
IA
Adebo
O A
OA
Osinowo
O
O
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D004106:Dilatation; D004935:Esophageal Diseases / Q000601:surgery; D004940:Esophageal Stenosis / Q000209:etiology* / Q000628:therapy*; D016629:Esophagectomy / Q000009:adverse effects*; D004946:Esophagostomy / Q000009:adverse effects*; D004947:Esophagus / Q000601:surgery*; D005774:Gastrostomy / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009055:Mouth; D009549:Nigeria; D013270:Stomach / Q000601:surgery*; D007507:Therapeutic Irrigation / Q000379:methods*; D016896:Treatment Outcome; D014945:Wound Healing