title: Minimally invasive management of postoperative esophagojejunal anastomotic leak.
abstract: OBJECTIVE
  Postoperative esophagojejunal fistula induces morbidity and mortality after total gastrectomy and affects the long-term survival rate.
  
  
  METHODS
  Between 2003 and 2011, 38 patients underwent laparoscopic total gastrectomy and 2 developed an esophagojejunal fistula.
  
  
  RESULTS
  The diagnosis was established by a computed tomography scan with contrast ingestion. The absence of complete dehiscence and the vitality of the alimentary loop were checked during laparoscopic exploration, associated with effective drainage. During the endoscopy, dehiscence was assessed and a covered stent and nasojejunal tube were inserted for enteral feeding. The leaks healed progressively, oral feeding was resumed and the drains removed within 3 weeks. The stent was removed 6 weeks. Three months later, the patients were able to eat without dysphagia.
  
  
  CONCLUSIONS
  Early diagnosis allows successful conservative management. The objectives are effective drainage, covering by an endoscopic stent and renutrition. Management by a multidisciplinary team is essential.
authors.affiliation: *Unité des Maladies de l'Appareil Digestif et Endocrine (UMADE) †Department of Radiology, Centre Hospitalier de Luxembourg, Luxembourg, UK.
authors.forename: Olivier
authors.initials: O
authors.lastname: Facy
authors.forename: Martine
authors.initials: M
authors.lastname: Goergen
authors.forename: Virginie
authors.initials: V
authors.lastname: Poulain
authors.forename: Frank
authors.initials: F
authors.lastname: Heieck
authors.forename: Vincent
authors.initials: V
authors.lastname: Lens
authors.forename: Juan-Santiago
authors.initials: JS
authors.lastname: Azagra
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000601:surgery*; D004937:Esophageal Fistula / Q000601:surgery*; D005743:Gastrectomy; D006801:Humans; D007412:Intestinal Fistula / Q000601:surgery*; D007579:Jejunal Diseases / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D013274:Stomach Neoplasms / Q000601:surgery; D016896:Treatment Outcome