Trans-oral irrigation for the management of cervical esophagogastric anastomotic leak

Afr J Med Med Sci. 2002 Mar;31(1):5-8.

Abstract

Over a period of 8 years, 15 of the 65 patients who had transhiatal esophagectomy (THE) for esophageal diseases and cervical esophagogastrostomy had cervical oesophagogastric anastomotic leak. Seven of the 18 patients (38.9%) with corrosive esophageal strictures (CES) due to acid burns had anastomotic leaks while 2 out of 6 patients (33.3%) and 6 out of 41 patients (14.6%) were the incidences of anastomotic leaks among alkali burnt and carcinoma of the esophagus. Anastomotic leaks were more commonly associated with surgery for CES. They were managed by trans-oral irrigation with water after ingestion of either soft/solid diet or high protein, high carbohydrate fluid diet along with adequate jejunostomy feeding. The age of the patients ranged between 5 to 65 years (mean 38.8 +/- 15.7 year). Anastomotic leaks were diagnosed between 3rd to 10th postoperative day (mean 7.1 +/- 2.6 day). The period of transoral irrigation before closure of leakage ranged from 2 to 14 days (mean 6.1 +/- 2.9). In 12 patients (80%) anastomotic leakage closed within 5 days, (mean 3.9 +/- 1.0). Two weeks after closure, all the patients had bouginage and every two weeks for another 3 dilation. Four of the 15 patients needed repeated two monthly dilation for 8 to 12 months. There were no other complications nor mortality in this study. There was psychological acceptance of this minimally invasive procedure.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Anastomosis, Surgical / adverse effects*
  • Child
  • Child, Preschool
  • Dilatation
  • Esophageal Diseases / surgery
  • Esophageal Stenosis / etiology*
  • Esophageal Stenosis / therapy*
  • Esophagectomy / adverse effects*
  • Esophagostomy / adverse effects*
  • Esophagus / surgery*
  • Gastrostomy / adverse effects*
  • Humans
  • Middle Aged
  • Mouth
  • Nigeria
  • Stomach / surgery*
  • Therapeutic Irrigation / methods*
  • Treatment Outcome
  • Wound Healing