Management of Leakage after Gastroesophageal Anastomosis

Abstract

Esophagectomy is needed for a variety of esophageal disorders, the most common indication is cancer esophagus, however, it is needed in benign disorders as postcorrosive strictures & endstage achalasia with esophageal dilatation. Anastomotic leakage is one of the most severe complications leading to significant morbidity and increased risk of mortality. Leaks after esophagectomy have different manifestations and vary in clinical presentations & complications, ranging from local wound infections to life threatening sepsis. Cervical leaks have higher incidence than their thoracic counterparts, but their clinical impact is less critical, because of the extra thoracic location without connection to the mediastinum. Most of the leaks develop within 10 days following surgery. Diagnosis of anastomotic leakage after esophagectomy can be difficult. Most surgeons use a contrast swallow routinely for patients within 1 week of the operation to confirm anastomotic healing then the patient is allowed to resume swallowing. Others rely on gradual introduction of oral fluids and solids with close clinical monitoring and only request the contrast swallow if leakage is suspected.