Endoluminal management of anastomotic dehiscence after esophagectomy: an increasing quiver of options reflects the difficulty in realizing a definitive therapy.

摘要

Intrathoracic leakage after esophagogastrectomy is a dreaded and morbid complication that can be associated with a prolonged hospitalization and high mortality rate.1 The presentation and subsequent management of an intrathoracic leak depends on the defect size and location within the gastric conduit or the esophagogastric anastomosis. Therefore, in the initial management, it is important to define whether intrathoracic leakage is secondary to (1) gastric conduit necrosis, (2) conduit staple line dehiscence, or (3) esophagogastric anastomosis dehiscence.2 Gastric conduit necrosis presents early in the perioperative interval and manifests with profound systemic sepsis requiring immediate surgical intervention. Staple line and esophagogastric anastomosis dehiscence, which occur early in the perioperative period, are also associated with a high degree of intrathoracic contamination and systemic sepsis and may require surgical intervention. However, late intrathoracic leakage arising from an isolated and limited defect within the staple line or anastomosis may be associated with little or no intrathoracic contamination and can be managed nonoperatively if adequate drainage can be achieved, infection treated, and enteral nutrition established. However, because no consensus for optimal treatment has been formulated, the appropriate treatment is usually individualized to the scenario encountered, and there is a high degree of variability among providers.