Effectiveness of Sternocleidomastoid Flap Repair for Cervical Anastomotic Leakage after Esophageal Reconstruction

Abstract

Background/Aims: The purpose of this study was to investigate the effectiveness of sternocleidomastoid (SCM) flap repair for anastomotic leakage after esophagectomy. Methods: A refractory cutaneous fistula from the gastric stump developed in 8 patients with esophageal cancer who underwent esophagogastric anastomosis after esophagectomy. All patients underwent SCM flap repair. The cutaneous fistula was removed and resutured. The sternal head of the left SCM was dissected from the manubrium of the sternum and sutured onto the repaired gastric stump. Results: The operative duration was 80-220 min (median, 120 min). The amount of intraoperative bleeding ranged from 5 to 182 g (median, 15 g). The absence of recurrent anastomotic leakage was confirmed after the SCM flap repair in every patient. Oral intake was initiated 7-15 days (median, 10 days) after the repair operation without discomfort. Conclusions: SCM flap repair is an effective and minimally invasive treatment method for cervical anastomotic leakage after esophageal reconstruction. This method may be considered in patients with refractory leakage of the gastric stump after staple anastomosis. i 2014 S. Karger AG, Basel

Diagnosis, assessment, and management of surgical complications following esophagectomy

“…Surgical options include pedicled muscle flap (such as sternocleidomastoid, pectoralis major, or, as described below, intercostal muscle) repair for complex cervical fistulas/leaks . If gastric fundic tip necrosis (local ischemia) is present, resection of the necrotic tissue and refashioning of the anastomosis, if possible, are necessary .…”

“…Surgical options include pedicled muscle flap (such as sternocleidomastoid, pectoralis major, or, as described below, intercostal muscle) repair for complex cervical fistulas/leaks. 91,92 If gastric fundic tip necrosis (local ischemia) is present, resection of the necrotic tissue and refashioning of the anastomosis, if possible, are necessary. 59 In the face of gross or diffuse ischemia of the gastric conduit, diversion surgery, dismantling the gastric pull-up, and placing a temporary esophagostomy with staged colonic interposition is inevitable.…”

Stem-Cell Therapy for Esophageal Anastomotic Leakage by Autografting Stromal Cells in Fibrin Scaffold

“…It may cause mediastinitis or pyothorax in early postoperative period and prolong the hospital stay. Conservative strategies including adequate drainage and infection control or even aggressive surgical repair for the treatment of EAL are not yet satisfactory . In recent years, MSC transplantation has proved to be a promising strategy in cell therapy and regenerative medicine for various diseases and numerous clinical applications are under study in ischemic heart disease, atherosclerosis, stroke, diabetes, and organ's reconstruction .…”

Effectiveness and safety of bovine pericardium patch repair for cervical anastomotic leakage after oesophagectomy for cancer

“…The sternocleidomastoid muscle can be transplanted in the same field for the repair of cervical anastomotic fistula. Compared with the pectoralis major muscle flap, the extent of the sternocleidomastoid flap translocation is relatively minimal (17). In contrast, the BPP is used for anastomotic fistula repair, and its operation is minimally invasive.…”