title: Iatrogenic esophageal injuries: evidence-based management for diagnosis and timing of contrast studies after repair.
abstract: Leakage from gastroesophageal repair is considered a major complication and is often associated with increased hospital stay, morbidity, and mortality. Management of these patients is variable among surgeons. Cases managed by the thoracic surgical service from March 1, 2010 to March 1, 2011 were retrospectively reviewed. Eight patients met criteria for inclusion: 4 were repaired primarily, 2 by debridement with diversion, and 2 by Ivor-Lewis resection and reconstruction. Esophograms were completed between 1 and 7 days postoperatively. Of the 8 patients treated, there was 1 mortality (12%) due to fungal mediastinitis. Soluble contrast imaging revealed 2 leaks (25%), 1 contained and 1 diffuse, which was the only mortality. Changes in clinical status, even minor, require contrast imaging of the esophagus to assess repair integrity. Timing of contrast study is variable in the literature, averaging 5 to 14 days. A conservative time frame is 7 days, unless any clinical suspicion of an esophageal leak exists.
authors.affiliation: Department of Surgery, University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas 76107, USA.
authors.forename: Ellen
authors.initials: E
authors.lastname: Ko
authors.forename: A H
authors.initials: AH
authors.lastname: O-Yurvati
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D004939:Esophageal Perforation / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D005260:Female; D015391:Gastroplasty / Q000009:adverse effects*; D059685:Herniorrhaphy / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome