Negative Pressure Therapy Versus Conventional Dressing for Management of Anastomotic Leak After Transhiatal Esophagectomy

Abstract

Transhiatal esophagectomy (THE) with cervical esophagogastric anastomosis is done for esophageal carcinoma and various benign lesions of the esophagus. Cervical anastomotic (CA) leak following THE is a serious complication that adds significantly to morbidity. As these leaks usually manifest in neck, local wound care is one of the essential components to manage such leaks. This study aims to evaluate the effect of negative pressure therapy (NPT) on healing of cervical wound following CA leaks. The record of all patients, who underwent THE for benign or malignant lesion of the esophagus from 2012 to 2019, was retrospectively analyzed. Of all the patients who had CA leak, patients with type II CA leak were only included for further analysis. The outcome of the patients who received NPT for wound care was compared with those who received simple wound dressings in terms of time to oral feed, hospital stay, mortality, and dysphagia at 6 months. Seventy-two patients were thus identified and 18 (25%) had an anastomotic leak. Patients with type II leaks (n = 16) were successfully managed by conservative approach. NPT for wound care in these patients was associated with significant reduction in hospital stay and early resumption of oral intake (p < 0.05) as compared with simple wound dressings. Conservative approach is effective for management of CA leaks. NPT for wound care significantly reduces associated morbidity.