Laparoscopic Approach for Esophagojejunal Anastomotic Leak in Patients Requiring Re-Look Intervention: How We Do It

Abstract

Background: Esophagojejunal anastomotic leak (EJAL) is a serious and often a life-threatening complication following total gastrectomy. There is no standard management strategy, and the optimal approach remains controversial. Whilst non-operative approach (with or without percutaneous drainage), endoscopic approach (stents, clips, and vacuum devices) is the preferred initial management, and there remains a subset of EJAL patients that require operative intervention because of the uncontrolled leak with sepsis and potential high mortality. Methods: We present early clinical results of a minimally invasive novel surgical technique (continuous suction isoperistaltic jejuno-esophagostomy tube, SIJET) to divert saliva and enteric secretions away from the anastomotic area thus creating a hypothesised concept of “no leak” scenario. The details of this technique are described and illustrated. Results: This is the first clinical report of a laparoscopic technique for insertion of SIJET in two patients with esophagojejunal anastomotic leaks managed successfully. Both patients had failed to progress on non-operative management because of the uncontrolled leak with sepsis. Conclusion: The absolute prerequisite for complete healing of an anastomotic leak is adequate drainage of undrained fluid collections and diversion of luminal fluid away from the anastomotic defect. Laparoscopic SIJET provides a minimally invasive option for the management of esophagojejunal leak following total gastrectomy in patients with uncontrolled leak with sepsis.