Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma

Lang, Hauke; Piso, P.; Stukenborg, C.; Raab, R.; Jähne, J.

doi:10.1053/ejso.1999.0764

Cited by 224 publications

(223 citation statements)

References 15 publications

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“…If detected and leakage is minor it can be successfully managed with percutaneous drainage [92,93] . Some authors advocate the use of conservative management techniques for treating anastomotic leakage such as placement of a nasojejunal tube combined with percutaneous drainage of abscess [94] . In this study this approach was associated with lower mortality rates compared to operative intervention.…”

Section: Advances In Postoperative Carementioning

confidence: 99%

Improving the outcomes in gastric cancer surgery

Tegels¹,

Maat²,

Hulsewé³

et al. 2014

WJG

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Section: Advances In Postoperative Carementioning

confidence: 99%

Improving the outcomes in gastric cancer surgery

Tegels¹,

Maat²,

Hulsewé³

et al. 2014

WJG

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“…13,15,16 Postoperative leaks after esophagectomy occur in up to 35% of cases 17 and 4% to 27% after gastrectomy, carrying a mortality as high as 65%. 18,19 Intrathoracic leak following esophagectomy carries higher mortality compared to cervical leak 20 and if there is a delay in treatment for over 24 hours, mortality approaches as high as 50%. 21 Endoscopic closure of esophageal leaks was first demonstrated by Schubert et al 22 in which clips were used to treat smaller esophageal leaks.…”

Section: Endoscopic Clipsmentioning

confidence: 99%

“…Postoperative leaks after esophagectomy and gastrectomy occurs in about 7%-8% of cases when done for malignancy 18,53 with mortality approaching over 50% if diagnosis is delayed. 18,33,53 First successful use of esophageal stents in patients with leaks following esophagectomy and gastrectomy was demonstrated by Langer et al 54 by using Polyflex SEPS (Boston Scientific, Marlborough, MA, USA). Although initial success rate was good, stent migration occurred in about 50% of the patients.…”

Section: Endoluminal Stentsmentioning

confidence: 99%

Endoscopic management of postoperative fistulas and leaks

Devaraj

Gavini

2017

Int J Gastrointest Interv

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Postoperative complications from gastrointestinal surgery can be associated with significant morbidity, and mortality especially if repeat surgery is needed to address these complications. There are wide array of endoscopic interventions and tools available for management of these complications using minimally invasive methods thus decreasing length of hospitalization, morbidity and leading to better patient outcomes. With the advent new tools like Overstitch device, Over the Scope Clip, fibrin glue, etc., these complications can be managed successfully with minimal morbidity. We provide an indepth discussion about available endoscopic options and their application in various scenarios in our article. Endoscopist should be familiar with these complications and endoscopic tools to promote use of these tools and techniques to achieve successful management of these complex conditions.

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“…Intrathoracic leak rates after esophageal resection occur in 7.9% of the surgeries (1) and after gastrectomy in 4% to 27% (2,3). Endoscopy is useful in diagnosis because the defect, integrity of surrounding tissue, and infection in the adjacent tissue can be assessed.…”

Section: Introductionmentioning

confidence: 99%

Self-expanding metal stents in postoperative esophageal leaks

Rodrigues‐Pinto¹,

Pereira²,

Ribeiro³

et al. 2016

Rev Esp Enferm Dig

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Background: Postoperative esophageal leaks have a high morbidity and mortality. Self-expanding metal stents (SEMS) have been used as an alternative to re-operation.Aim: Evaluating predictors of success of SEMS in postoperative esophageal leaks.Methods: Retrospective study of patients with postoperative esophageal leaks referred for SEMS placement in a reference center during a period of 3 years. Technical success was defined as closure of the leak in barium swallow at 15 days. Clinical success was considered as endoscopic and/or radiographic confirmation of closure after stent removal.Results: Thirteen patients placed SEMS. Median follow-up was 58 days. Leaks had a median size of 20 mm. Time between surgery and SEMS placement was 20 days. One patient died 2 days after SEMS placement and one had worsening of the fistula after SEMS expansion. Time till stent migration was 9 days. Technical success was achieved in 9 of 11 patients, with clinical success without recurrence in 5 patients. All leaks with less than 20 mm were solved endoscopically. Technical and clinical success was higher when time between surgery and SEMS placement was lower, even though without statistical significance (respectively, p = 0.228 and 0.374). In the 8 patients who died during follow-up, median survival was 59 days.Conclusions: Technical success of SEMS was higher than 80%; however, due to high morbidity and mortality, only 45% of patients had their stent removed. Lower time from diagnosis to SEMS placement and leak size less than 20 mm may be associated with better results.

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Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma

Cited by 224 publications

References 15 publications

Improving the outcomes in gastric cancer surgery

Improving the outcomes in gastric cancer surgery

Endoscopic management of postoperative fistulas and leaks

Self-expanding metal stents in postoperative esophageal leaks

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