Trans-oral irrigation for the management of cervical esophagogatric anastomotic leak

Abstract

Over a period of 8 years, 15 of the 65 patients who had transhiatal esophagectomy (THE) for esophageal diseases and cervical esophagogastrostomy had cervical esophagogastric anastomotic leak. Seven of the 18 patients (38.9%) with corrosive esophageal strictures (CBS) due to acid burns had anastomotic leaks while 2 out of 6 patients (33.3%) and 6 out of 41 patients (14.6%) were the incidences of anastomotic leaks among alkali burnt and carcinoma of the esophagus. Anastomotic leaks were more commonly associated with surgery for CES. They were managed by trans-oral irrigation with water after ingestion of either soft/solid diet or high protein, high carbohydrate fluid diet along with adequate jejunostomy feeding. The age of the patients ranged between 5 to 65 years (mean 38.8 ± 15.7 year). Anastomotic leaks were diagnosed between 3rd to I0, h postoperative day (mean 7.1 ± 2.6 day). The period of transoral irrigation before closure of leakage ranged from 2 to 14 days (mean 6.1 ± 2.9). In 12 patients (80%) anastomotic leakage closed within 5 days, (mean 3.9 ± 1.0). Two weeks after closure, all the patients had bouginage and every two weeks for another 3 dilations. Four of the 15 patients needed repeated two monthly dilation for 8 to 12 months. There were no other complications nor mortality in this study. There was psychological acceptance of this minimally invasive procedure.