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Management ofanastomotic leaksafter esophagectomyand gastric pull-up Amber FamigliettiJohn F. LazarHayley R. Henderson2020 год

Management of anastomotic leaks after esophagectomy and gastric pull-up
review

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Аннотация: Abstract: Anastomotic leak is one of the most feared complications of esophagectomy, leading to prolonged hospital stay, increased postoperative mortality, and additional cost both to the patient and the hospital. Historically, anastomotic leaks have been treated with several techniques including conservative measures, percutaneous or operative drainage, primary surgical repair with buttressing, T-tube drainage, or excision of the esophageal replacement conduit with end esophagostomy. With advances in treatment modalities, including endoscopic stenting, clips and suturing, endoluminal vacuum-assisted closure (EVAC), such leaks increasingly are being managed without operative re-intervention and with salvage of the esophageal replacement conduit. For the purposes of this review, we identified studies analyzing the management of postoperative leak after esophagectomy. We then compared the efficacy of the various newer modalities for closure of anastomotic leaks and gastric conduit defects. We found both esophageal stent and EVAC sponges are effective treatments for closure of anastomotic leak. The chosen treatment modality for salvage of the esophageal replacement conduit is entirely dependent on the patient's clinical status and the surgeon's preference and experience. Emerging endoscopic and endoluminal therapies have increased the armamentarium of tools the esophageal surgeon has to facilitate successful resolution of anastomotic leaks following esophagectomy with reconstruction. While some literature suggests that EVACs have a slightly superior result in conduit success, we question this endorsement as EVACs mostly are utilized for contained leaks, many of which may have healed with conservative measures. This poses a challenge as there is clearly a bias given patient selection.
Год издания: 2020
Авторы: Amber Famiglietti, John F. Lazar, Hayley R. Henderson, Margaret E. Hamm, Stefanie Malouf, Marc Margolis, Thomas J. Watson, Puja Gaur
Издательство: AME Publishing Company
Источник: Journal of Thoracic Disease
Ключевые слова: Esophageal and GI Pathology, Esophageal Cancer Research and Treatment, Gastric Cancer Management and Outcomes
Другие ссылки: Journal of Thoracic Disease (PDF)
Journal of Thoracic Disease (HTML)
Europe PMC (PubMed Central) (PDF)
Europe PMC (PubMed Central) (HTML)
PubMed Central (HTML)
PubMed (HTML)