Surgical treatment of anastomotic leaks after oesophagectomy.
OBJECTIVE
To determine the optimum management of anastomotic leaks after oesophagectomy.


METHODS
We undertook a retrospective review of 23 patients who developed anastomotic leakage, out of 389 patients undergoing oesophagectomy with gastric interposition. The presentation, diagnosis, and treatment of the leaks, and patient outcomes are analysed.


RESULTS
Leaks occurred from 3 to 23 (median=7.5) days after surgery. Clinical features included fever (57%), leucocytosis (52%), dysphagia (4%), coughing bile (4%), wound infection (13%), pneumothorax (35%), pleural effusion (70%) and septicaemia (70%). All but one leak was due to variable degree of gastric tip necrosis. Contrast swallow showed leakage in only 14 (61%) patients, whereas oesophagoscopy confirmed all the leaks. Surgical treatment (resection of necrotic stomach and either immediate or staged re-anastomosis, or end-oesophageal exteriorisation) was the primary treatment in 17 patients of whom 15 survived to discharge. Two out of the 6 patients treated non-surgically died.


CONCLUSIONS
Diagnosis of anastomotic leakage after oesophagectomy is difficult due to its variable presentation and the unreliability of contrast swallow. Gastric tip necrosis is by far the most common cause. We feel our preferred strategy of immediate surgical treatment of symptomatic leaks is justified by the favourable outcome in the majority of patients.
Page
Richard D
RD
Department of Thoracic Surgery, The Cardiothoracic Centre, Thomas Drive, Liverpool L14 3PE, UK. richard.page@ctc.nhs.uk
Shackcloth
Michael J
MJ
Russell
Glenn N
GN
Pennefather
Stephen H
SH
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D004938:Esophageal Neoplasms / Q000401:mortality / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D004945:Esophagoscopy / Q000379:methods; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D012086:Reoperation; D018805:Sepsis / Q000209:etiology / Q000401:mortality; D013270:Stomach / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome