Can the intraoperative leak test prevent postoperative leakage of esophagojejunal anastomosis after total gastrectomy?
OBJECTIVE
Anastomotic failures that cannot be detected during surgery often lead to postoperative leakage. There have been no detailed reports on the intraoperative leak test for esophagojejunal anastomosis. Our purpose was to investigate the utility of routine intraoperative leak testing to prevent postoperative anastomotic leakage after performing esophagojejunostomy.


METHODS
We prospectively performed routine air leak tests and reviewed the records of 185 consecutive patients with gastric cancer who underwent open total gastrectomy followed by esophagojejunostomy.


RESULTS
A positive leak test was found for six patients (3.2 %). These patients with positive leak tests were subsequently treated with additional suturing, and they developed no postoperative anastomotic leakage. However, anastomotic leakage occurred in nine patients (4.9 %) with negative leak tests. A multivariate analysis demonstrated that a patient age >75 years and the surgeon's experience <30 cases were risk factors for anastomotic leakage.


CONCLUSIONS
Intraoperative leak testing can detect some physical dehiscence, and additional suturing may prevent anastomotic leakage. However, it cannot prevent all anastomotic leakage caused by other factors, such as the surgeons' experience and patients' age.
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan. kanashin@med.kobe-u.ac.jp.
Shingo
S
Kanaji
Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan.
Masato
M
Ohyama
Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan.
Takashi
T
Yasuda
Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan.
Hiroyoshi
H
Sendo
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Satoshi
S
Suzuki
Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan.
Kentaro
K
Kawasaki
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Kenichi
K
Tanaka
Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan.
Yasuhiro
Y
Fujino
Department of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan.
Masahiro
M
Tominaga
Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Yoshihiro
Y
Kakeji
D000368:Aged; D057868:Anastomotic Leak / Q000175:diagnosis* / Q000517:prevention & control*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005743:Gastrectomy; D006801:Humans; D007432:Intraoperative Period; D007582:Jejunostomy; D007583:Jejunum / Q000601:surgery*; D008297:Male; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies
Esophagojejunal anastomotic leakage; Leak test; Total gastrectomy