Postoperative esophageal leak management with the Polyflex esophageal stent.
OBJECTIVE
Leak after esophageal anastomosis or perforation repair prolongs hospitalization, prevents oral hydration and nutrition, and can produce localized infection or sepsis. This investigation reviews our experience treating postoperative esophageal leaks with the Polyflex esophageal stent (Boston Scientific, Natick, Mass).


METHODS
Over a 30-month period, patients with a postoperative esophageal leak were treated with the Polyflex stent for leak occlusion. Leak occlusion was confirmed by means of esophagraphy. Patients were followed until their stent was removed and their esophageal leak had resolved.


RESULTS
Twenty-one patients had 27 stents placed for leak occlusion after esophagectomy (n = 5), esophageal perforation (n = 5), surgical (n = 4) or endoscopic (n = 2) antireflux procedure, and esophageal diverticulectomy (n = 3) or myotomy (n = 2). The mean interval between surgical intervention and stent placement was 12 +/- 8 days (range, 3-31 days). Occlusion of the leak occurred in 20 patients. One patient experienced a dehiscence of the surgical esophageal perforation repair requiring esophageal diversion. Stent migration requiring repositioning (n = 3) or replacement (n = 4) occurred in 5 (24%) patients. Twenty (95%) stents were removed without residual leak (mean, 51 +/- 43 days; range, 15-175 days). One patient had a stricture after stent removal that required endoscopic dilatation. One patient in this series died.


CONCLUSIONS
The Polyflex esophageal stent is an effective method for occluding a postoperative esophageal leak. It rapidly eliminates contamination of the mediastinum, pleura, and peritoneum; allows oral hydration and nutrition; and is easily removable. These stents also offer an appealing alternative to traditional esophageal diversion and subsequent reconstruction in patients with a persistent esophageal leak.
Freeman
Richard K
RK
Department of Thoracic and Cardiovascular Surgery, St Vincent Hospital, Indianapolis, Ind, USA. RFreeman@corvascmds.com
Ascioti
Anthony J
AJ
Wozniak
Thomas C
TC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D020099:Coated Materials, Biocompatible; D015331:Cohort Studies; D004724:Endoscopy / Q000379:methods; D004935:Esophageal Diseases / Q000175:diagnosis / Q000601:surgery; D004937:Esophageal Fistula / Q000209:etiology / Q000601:surgery*; D004939:Esophageal Perforation / Q000209:etiology / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects* / Q000379:methods; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D018570:Risk Assessment; D012828:Silicones / Q000494:pharmacology; D015607:Stents; D016896:Treatment Outcome
D020099:Coated Materials, Biocompatible; D012828:Silicones