Feasibility And Safety Of Early Oral Feeding After Cervical Esophagogastrostomy

Abstract

Cervical esophagogastrostomy has proved to be a safe and satisfying procedure after esophageal resection or bypass but leak rates in the range of 5 to 44% have been reported. Although these leaks are not as catastrophic as with a thoracic anastomosis, the surgeon is still faced with a demoralized patient who cannot be started on oral feeds due to a leak in the neck followed by stricture formation. Presently we routinely give oral feeding to our patient on the 5th postoperative day. To further decrease the postoperative stay and to evaluate the feasibility and safety of early oral feeding after cervical esophagogastrostomy this study was proposed. Of 35 patients included in this study, 19 were randomized to undergo a gastrografin study on the 3rd postoperative day (2 patients could not undergo the study as they are in ICU and ventilator) and 16 on the 5th postoperative day. Clinically if no leak was demonstrated, oral feeding was started on the same day. Out of 17 patients in group I (3rd day), one had a leak on gastrografin study and four had clinical leaks after oral feeding. The person who had a leak on gastrografin study did not have any clinical leak and was allowed orally and never had a clinical leak. Four persons who had clinical leaks (between 4 to 8 days) did not have any leak on gastrografin study and all were managed conservatively. Of 16 patients in group II (5th day), 3 had clinical leaks after oral feeding and gastrografin study was able to detect leak in only one of these who were managed conservatively. The difference between both groups was not statistically significant. One of the patients who was on ventilator and could not undergo gastrografin study expired due to respiratory insufficiency and multiple organ failure whereas all the remaining patients were discharged. The mean hospital stay in third day group was 13.6 days and in fifth day group was 12.2 days which was not statistically significant.