Abstract
To evaluate the incidence of fistula and stenosis of the cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach after subtotal esophagectomy. We studied 54 patients who underwent subtotal esophagectomy, 45 (83.3%) patients with carcinoma and nine (16.6%) with advanced megaesophagus. In all cases the cervical esophagogastric anastomosis was performed with the invagination of the proximal esophageal stump inside the stomach. Three (5.5%) patients had a fistula at the esophagogastric anastomosis, two of whom with minimal leakage of air or saliva and with mild clinical repercussion; the third had a low output fistula that drained into the pleural space, and this patient developed empyema that showed good progress with drainage. Fibrotic stenosis of anastomosis occurred in thirteen (24%) subjects and was treated successfully with endoscopic dilatation. Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula and stenosis, thus becoming an attractive option for the reconstruction of alimentary transit after subtotal esophagectomy.
Highlights
Esophagectomy is a complex surgical procedure and has as its main purpose the esophageal cancer treatment[1]
We studied 54 patients who underwent subtotal esophagectomy and esophagogastroplasty
Five (9.2%) patients had serious complications which led to death: two as a result of bronchopneumonia, one due to multiple organ failure after acute cholecystitis, one from sepsis following ischemic necrosis of the stomach and the last due to mesenteric trombosis; all of them with no relation with abnormalities in the esophagogastric anastomosis
Summary
Esophagectomy is a complex surgical procedure and has as its main purpose the esophageal cancer treatment[1]. Esophagectomy is a major surgery that has both a high morbidity rate (60%) and mortality rate, which may reach 26.7%, mainly due to pulmonary complications, cervical fistulas, stenosis of anastomosis, necrosis of the tubularized stomach, and mediastinitis[3,4,5,6]. Among these possible complications, fistulas of the esophagogastric anastomosis represent one of the main problems of esophagectomies. 30% to 50% of those patients who present with fistula go on to develop stenosis[5]
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