Display options
Cite
Famiglietti A, Lazar JF, Henderson H, et al. Management of anastomotic leaks after esophagectomy and gastric pull-up. J Thorac Dis. 2020;12(3):1022-1030doi: 10.21037/jtd.2020.01.15.
Famiglietti, A., Lazar, J. F., Henderson, H., Hamm, M., Malouf, S., Margolis, M., Watson, T. J., & Khaitan, P. G. (2020). Management of anastomotic leaks after esophagectomy and gastric pull-up. Journal of thoracic disease, 12(3), 1022-1030. https://doi.org/10.21037/jtd.2020.01.15
Famiglietti, Amber, et al. "Management of anastomotic leaks after esophagectomy and gastric pull-up." Journal of thoracic disease vol. 12,3 (2020): 1022-1030. doi: https://doi.org/10.21037/jtd.2020.01.15
Famiglietti A, Lazar JF, Henderson H, Hamm M, Malouf S, Margolis M, Watson TJ, Khaitan PG. Management of anastomotic leaks after esophagectomy and gastric pull-up. J Thorac Dis. 2020 Mar;12(3):1022-1030. doi: 10.21037/jtd.2020.01.15. PMID: 32274171; PMCID: PMC7139088.
Copy Download .nbib Format: NLM
Share it on

J Thorac Dis. 2020 Mar;12(3):1022-1030. doi: 10.21037/jtd.2020.01.15.

Management of anastomotic leaks after esophagectomy and gastric pull-up.

Journal of thoracic disease

Amber Famiglietti, John F Lazar, Hayley Henderson, Margaret Hamm, Stefanie Malouf, Marc Margolis, Thomas J Watson, Puja Gaur Khaitan

Affiliations

  1. Department of Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA.
  2. Division of Thoracic and Esophageal Surgery, Georgetown University School of Medicine, MedStar Washington Hospital Center, Washington, DC, USA.

PMID: 32274171 PMCID: PMC7139088 DOI: 10.21037/jtd.2020.01.15

Abstract

Anastomotic leak is one of the most feared complications of esophagectomy, leading to prolonged hospital stay, increased postoperative mortality, and additional cost both to the patient and the hospital. Historically, anastomotic leaks have been treated with several techniques including conservative measures, percutaneous or operative drainage, primary surgical repair with buttressing, T-tube drainage, or excision of the esophageal replacement conduit with end esophagostomy. With advances in treatment modalities, including endoscopic stenting, clips and suturing, endoluminal vacuum-assisted closure (EVAC), such leaks increasingly are being managed without operative re-intervention and with salvage of the esophageal replacement conduit. For the purposes of this review, we identified studies analyzing the management of postoperative leak after esophagectomy. We then compared the efficacy of the various newer modalities for closure of anastomotic leaks and gastric conduit defects. We found both esophageal stent and EVAC sponges are effective treatments for closure of anastomotic leak. The chosen treatment modality for salvage of the esophageal replacement conduit is entirely dependent on the patient's clinical status and the surgeon's preference and experience. Emerging endoscopic and endoluminal therapies have increased the armamentarium of tools the esophageal surgeon has to facilitate successful resolution of anastomotic leaks following esophagectomy with reconstruction. While some literature suggests that EVACs have a slightly superior result in conduit success, we question this endorsement as EVACs mostly are utilized for contained leaks, many of which may have healed with conservative measures. This poses a challenge as there is clearly a bias given patient selection.

2020 Journal of Thoracic Disease. All rights reserved.

Keywords: Esophagectomy; anastomotic leak; endoluminal stent; endoluminal suturing; endoluminal vacuum-assisted closure (EVAC); over-the-scope clips (OTSCs)

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

References

  1. Ann Thorac Surg. 2014 Apr;97(4):1459-63 - PubMed
  2. Endoscopy. 2015;47 Suppl 1 UCTN:E376-7 - PubMed
  3. Int J Colorectal Dis. 2018 Jan;33(1):91-93 - PubMed
  4. Surg Endosc. 2017 Jun;31(6):2687-2696 - PubMed
  5. Thorac Surg Clin. 2018 Nov;28(4):541-554 - PubMed
  6. Endoscopy. 2013 Jun;45(6):433-8 - PubMed
  7. Ann Surg. 2019 Nov;270(5):820-826 - PubMed
  8. Langenbecks Arch Surg. 2018 Aug;403(5):607-614 - PubMed
  9. J Cardiothorac Surg. 2017 Jan 25;12(1):4 - PubMed
  10. Surg Endosc. 2014 Mar;28(3):896-901 - PubMed
  11. Cardiovasc Intervent Radiol. 2011 Dec;34(6):1267-71 - PubMed
  12. Dis Esophagus. 2016 Aug;29(6):572-9 - PubMed
  13. Ann Thorac Cardiovasc Surg. 2016 Dec 20;22(6):363-366 - PubMed
  14. Dis Esophagus. 2017 Jan 1;30(1):1-8 - PubMed
  15. Surg Obes Relat Dis. 2010 May-Jun;6(3):282-8 - PubMed
  16. World J Gastroenterol. 2019 Jan 21;25(3):356-366 - PubMed
  17. Gastrointest Endosc. 2008 Apr;67(4):708-11 - PubMed
  18. Radiographics. 2016 Jan-Feb;36(1):107-21 - PubMed
  19. BMC Surg. 2019 Apr 11;19(1):37 - PubMed
  20. Ann Thorac Surg. 2014 Mar;97(3):1071-3 - PubMed
  21. Endoscopy. 2014;46 Suppl 1 UCTN:E623-4 - PubMed
  22. Ann Thorac Surg. 2010 Nov;90(5):1674-81 - PubMed
  23. Eur J Surg Oncol. 2017 Feb;43(2):258-269 - PubMed
  24. Semin Thorac Cardiovasc Surg. 2011 Summer;23(2):163-7 - PubMed
  25. Gastrointest Endosc. 2014 Oct;80(4):610-622 - PubMed
  26. Dis Esophagus. 2013 Aug;26(6):598-602 - PubMed
  27. J Gastroenterol Hepatol. 2019 Jan;34(1):22-30 - PubMed
  28. Dis Esophagus. 2013 Aug;26(6):609-15 - PubMed
  29. Surg Endosc. 2016 Aug;30(8):3297-303 - PubMed
  30. World J Surg Oncol. 2014 Dec 29;12:402 - PubMed
  31. J Gastrointest Surg. 2019 Jan;23(1):67-75 - PubMed
  32. J Gastrointest Surg. 2015 Jul;19(7):1229-35 - PubMed
  33. J Thorac Cardiovasc Surg. 2011 Jul;142(1):39-46.e1 - PubMed
  34. Interact Cardiovasc Thorac Surg. 2016 Jan;22(1):32-7 - PubMed
  35. J Gastrointest Surg. 2011 May;15(5):777-81 - PubMed
  36. Surg Endosc. 2018 Jan;32(1):204-211 - PubMed
  37. Ann Thorac Surg. 2015 Apr;99(4):1430-2 - PubMed
  38. J Thorac Cardiovasc Surg. 2017 Sep;154(3):1145-1150 - PubMed
  39. Surg Endosc. 2016 Jun;30(6):2473-80 - PubMed
  40. JSLS. 2018 Apr-Jun;22(2): - PubMed
  41. Ann Thorac Surg. 2013 Dec;96(6):1919-26 - PubMed
  42. Gastrointest Endosc. 2014 Mar;79(3):503-7 - PubMed
  43. Dis Esophagus. 2018 Nov 1;31(11): - PubMed
  44. Surg Clin North Am. 2012 Oct;92(5):1299-313 - PubMed
  45. Surg Endosc. 2020 Jan;34(1):142-152 - PubMed
  46. Gastrointest Endosc. 2015 Aug;82(2):397 - PubMed
  47. Aliment Pharmacol Ther. 2011 Jun;33(12):1292-301 - PubMed
  48. Medicine (Baltimore). 2016 Apr;95(16):e3416 - PubMed
  49. World J Gastroenterol. 2014 Jun 28;20(24):7767-76 - PubMed

Publication Types