Management of postoperative esophageal leaks with the Polyflex self-expanding covered plastic stent.
BACKGROUND
Esophageal anastomotic leaks can lead to prolonged hospitalization. In this article we present our experience with the placement of the Polyflex self-expanding plastic stent (Willy Ruesch GMBH, Kernen, Germany) for leak occlusion.


METHODS
Between April 2000 and November 2003, 24 patients were included into this prospective study and underwent Polyflex stent placement for postoperative esophageal anastomotic leaks. The primary operation was esophagectomy in 13 patients, gastrectomy in 7, cardia resection in 2, and other procedures in 2 patients. The median interval between operation and stent placement was 19 days (range, 4 to 65). The effectiveness of leak occlusion was evaluated by water-soluble contrast swallow and the clinical course.


RESULTS
In 2 patients stent misplacement produced an enlarged anastomotic dehiscence that necessitated reoperation. Radiologic evaluation was impossible in 4 patients because of their generally restricted condition. Among 18 evaluable patients, leak occlusion was successful with a single stent in 16 patients (89%) based on radiologic evaluation. Immediate oral feeding was well tolerated by these patients. After a median follow-up of 220 days (range, 7 to 1221), 9 cases of late stent dislocation were observed. Stent removal in patients after esophagectomy with gastric pull-up led to dysphagia from anastomotic strictures in 2 patients. Symptomatic strictures did not develop in the 5 evaluable postgastrectomy patients after stent removal.


CONCLUSIONS
The placement of self-expanding plastic stents is a highly effective treatment for esophageal anastomotic leaks. Because clinically-relevant anastomotic strictures can be expected, we do not recommend stent removal after esophagectomy with gastric pull-up reconstruction.
Langer
Felix B
FB
Department of Surgery, Division of General Surgery, Medical University of Vienna, Vienna, Austria.
Wenzl
Etienne
E
Prager
Gerhard
G
Salat
Andreas
A
Miholic
Johannes
J
Mang
Thomas
T
Zacherl
Johannes
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects; D000714:Anastomosis, Surgical / Q000009:adverse effects; D020099:Coated Materials, Biocompatible; D004867:Equipment Design; D004939:Esophageal Perforation / Q000209:etiology / Q000517:prevention & control*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010969:Plastics; D011446:Prospective Studies; D012086:Reoperation; D015607:Stents / Q000009:adverse effects
D020099:Coated Materials, Biocompatible; D010969:Plastics