Utility of silicone esophageal bypass stents in the management of delayed complex esophageal disruptions.
BACKGROUND
The objective of this study was to review the clinical experience of temporarily placing an endoesophageal silicone salivary bypass stent and its value in managing patients with life-threatening esophageal disruptions.


METHODS
Clinical records of patients undergoing placement of silicone Montgomery salivary bypass stents from June 1998 to September 2007 were reviewed. Seventeen patients had a proven esophageal disruption in the absence of malignancy and with life-threatening sepsis refractory to conventional management. Underlying conditions were iatrogenic trauma from prior pulmonary surgery (4 patients), significant anastomotic leaks after an esophagogastrectomy (4 patients), delayed presentation (> 24 hours) of a perforated esophagus (4 patients), leak after esophageal surgery (3 patients), and esophagobronchial fistula secondary to inflammation and infection (2 patients). Stents were placed without securing, were sutured in place to the esophageal wall at the time of thoracotomy, or were secured by bringing holding sutures through the nostrils and tied over the bridge of the nose.


RESULTS
In all cases, placement of the esophageal stent led to prompt improvement of the leak and, within a week, improvement of the sepsis. Supportive measures were continued after placement of the stent. Sixteen patients overcame the sepsis with ultimate healing of the esophageal disruption (13 patients) or maturation of the perforation into a chronic fistula (3 patients). Endoscopic stent removal was performed 2 to 16 weeks after placement. No patient had a stricture develop at the disruption site. One patient died of ruptured thoracic aorta.


CONCLUSIONS
Silicone salivary bypass stents serve as an effective way of diverting and excluding the oral-alimentary stream, thereby providing optimal conditions for sepsis control. They are a useful adjunct in the management of complex esophageal conditions.
Kim
Anthony W
AW
Department of Cardiovascular-Thoracic Surgery, Rush University Medical Center, Chicago, Illinois 60612, USA.
Liptay
Michael J
MJ
Snow
Norman
N
Donahue
Philip
P
Warren
William H
WH
D000293:Adolescent; D000328:Adult; D000368:Aged; D001983:Bronchial Fistula / Q000601:surgery*; D020878:Device Removal; D004937:Esophageal Fistula / Q000601:surgery*; D004939:Esophageal Perforation / Q000601:surgery*; D004947:Esophagus / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000601:surgery*; D019919:Prosthesis Implantation; D018805:Sepsis / Q000601:surgery*; D012826:Silicone Elastomers; D015607:Stents; D013529:Surgical Wound Dehiscence / Q000601:surgery*; D013537:Sutures; D013908:Thoracotomy; D016896:Treatment Outcome
D012826:Silicone Elastomers