Management of anastomotic leaks after oesophagectomy and gastric pull-up.

Abstract

To evaluate the effectiveness of endoscopic and surgical intervention in treating anastomotic leaks after oesophagectomy. Anastomotic leak after oesophagectomy is a severe complication associated with significant morbidity and mortality. This study aimed to analyse our experience with the management of anastomotic leak after oesophagectomy. A retrospective study evaluated the treatment outcome and duration of treatment in patients with anastomotic dehiscence or conduit necrosis after oesophagectomy from November 2008 to November 2021. The group consists of forty-seven patients. Twenty-one (44.7 %) patients had dehiscence of the neck anastomosis, twenty patients (42.6 %) had dehiscence of the chest anastomosis, and six (12.8 %) patients had conduit necrosis. Nineteen patients with dehiscence were primarily treated by endoscopic insertion of a self-expanding metal stent with perianastomotic drainage; the other patients were primarily treated surgically. Mortality associated with anastomosis dehiscence was 27.7 % (thirteen patients). Stent use in treatment was a statistically significant parameter regarding the length of hospital stay and mortality. Self-expanding metal stents can reduce leak-related morbidity and mortality after oesophagectomy and may be considered a cost-effective treatment alternative (Tab. 2, Fig. 2, Ref. 21).