title: Transnasal inner drainage: an option for managing anastomotic leakage after esophagectomy.
abstract: OBJECTIVE
  Anastomotic leakage, a serious complication of esophagectomy, continues to contribute to high surgery-related mortality. Management of anastomotic leakage has become a serious concern for surgeons. This study aimed to evaluate the utility of transnasal inner drainage using a Salem Sump tube for anastomotic leakage after esophagectomy.
  
  
  METHODS
  We inserted a Salem Sump tube into the esophagus through one nostril. By using a 0.035-inch guide wire under fluoroscopic guidance, we advanced this drainage tube into the abscess through the site of the anastomotic leakage. We also used upper endoscopy if necessary.
  
  
  RESULTS
  We performed transnasal inner drainage in five patients with anastomotic leakage after esophagectomy. The average interval from the operation to diagnosis of anastomotic leakage was 7.8 days (median: 7, range: 3-18 days). The average duration of drainage was 15.8 days (median: 16, range: 11-21 days). No patients required additional surgical treatment and there was no operative mortality. No stricture was observed during the follow-up period.
  
  
  CONCLUSIONS
  Transnasal inner drainage is successful, and may decrease the duration of drainage and reduce surgery-related mortality caused by anastomotic leakage. Additionally, this technique enables treatment of abscesses that cannot be managed by percutaneous drainage because of their locations, and can be safely undertaken in most institutions. Transnasal inner drainage is a safe, useful, inexpensive, and minimally invasive method, which may be an option for management of post-esophagectomy anastomotic leakage.
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Keisuke
authors: K
authors: Kosumi
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Yoshifumi
authors: Y
authors: Baba
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Nobuyuki
authors: N
authors: Ozaki
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Takahiro
authors: T
authors: Akiyama
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Kazuto
authors: K
authors: Harada
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Hironobu
authors: H
authors: Shigaki
authors: Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Yu
authors: Y
authors: Imamura
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Masaaki
authors: M
authors: Iwatsuki
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
authors: Naoya
authors: N
authors: Yoshida
authors: Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan.
authors: Masayuki
authors: M
authors: Watanabe
authors: Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. hdobaba@kumamoto-u.ac.jp.
authors: Hideo
authors: H
authors: Baba
mesh_terms: D000368:Aged; D057868:Anastomotic Leak / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D004322:Drainage / Q000379:methods*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007440:Intubation / Q000379:methods*; D008297:Male; D008875:Middle Aged
keywords: Anastomotic leakage; Complication; Esophagectomy; Transnasal inner drainage