title: A method for early diagnosis and treatment of intrathoracic esophageal anastomotic leakage: prophylactic placement of a drainage tube adjacent to the anastomosis.
abstract: OBJECTIVE
  Anastomotic leakage is a severe complication after esophagectomy, which results in high mortality and morbidity. In this study, we will preset a drainage tube adjacent to the anastomosis and evaluate its effect in the diagnosis and treatment of anastomotic leakage.
  
  
  METHODS
  We undertook a retrospective review of 414 patients who underwent partial esophageal resection or cardia resection with intrathoracic esophagogastric anastomosis. The patients were divided into two groups (Tube group and no-tube group) according to whether a drainage tube was placed adjacent to the anastomotic stoma during the surgical procedure. The leakage rate, time to diagnosis, time to flush, time to recovery, and patient outcome were analyzed.
  
  
  RESULTS
  The leakage rate in the tube group was 5.35% (6/112) while it was 3.64% (11/302) in the no-tube group. The total mortality among patients with anastomotic leakage was 29.41%. In the tube group, all the patients were definitively diagnosed the same day on which suspicion of leakage occurs while the patients in the no-tube group required further examination to diagnose. In the no-tube group, the patients required placement of a drainage tube with the help of computed tomography or ultrasonic examination while there was no need for further procedures in the tube group. The days to flush and recovery in the tube group were 23.4 ± 5.94 and 32.2 ± 10.84, respectively, while, in the no-tube group, it was 80.71 ± 48.41 and 98.14 ± 56.24 (P < 0.05).
  
  
  CONCLUSIONS
  In conclusion, prophylactic implantation of a drainage tube adjacent to the esophageal anastomosis is a good method for rapid diagnosis and treatment of leakage.
authors: Department of Thoracic and Cardiovascular Surgery, Shanghai Changzheng Hospital, The Second Military Medical University, No.415 Fengyang Road, Huangpu District, Shanghai, 200003, China.
authors: Hua
authors: H
authors: Tang
authors: Lei
authors: L
authors: Xue
authors: Jiang
authors: J
authors: Hong
authors: Xiandong
authors: X
authors: Tao
authors: Zhifei
authors: Z
authors: Xu
authors: Bin
authors: B
authors: Wu
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D002277:Carcinoma / Q000601:surgery; D004322:Drainage / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000009:adverse effects*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013270:Stomach / Q000601:surgery*; D013997:Time Factors