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

2014 ◽  
Vol 31 (4-5) ◽  
pp. 306-311 ◽  
Author(s):  
Masanobu Nakajima ◽  
Hitoshi Satomura ◽  
Masakazu Takahashi ◽  
Hiroto Muroi ◽  
Hiroyuki Kuwano ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Esophageal Reconstruction ◽  
Flap Repair

Repair using the pectoralis major muscle flap for anastomotic leakage after esophageal reconstruction via the subcutaneous route

Surgery ◽  
2010 ◽  
Vol 147 (2) ◽  
pp. 212-218 ◽  
Author(s):  
Masaru Morita ◽  
Keisuke Ikeda ◽  
Masahiko Sugiyama ◽  
Hiroshi Saeki ◽  
Akinori Egashira ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Pectoralis Major Muscle ◽  
Muscle Flap ◽  
Pectoralis Major ◽  
Esophageal Reconstruction ◽  
Subcutaneous Route ◽  
Pectoralis Major Muscle Flap

scholarly journals An Approach to Accelerate Healing and Shorten the Hospital Stay of Patients With Anastomotic Leakage After Esophagectomy: An Explorative Study of Systematic Endoscopic Intervention

2021 ◽  
Vol 11 ◽  
Author(s):  
LeQi Zhong ◽  
JiuDi Zhong ◽  
ZiHui Tan ◽  
YiTong Wei ◽  
XiaoDong Su ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Intervention Group ◽  
Healing Time ◽  
Diagnostic Group ◽  
Endoscopic Diagnosis ◽  
Conventional Group ◽  
Esophageal Reconstruction ◽  
Endoscopic Intervention ◽  
Conservative Group ◽  
Conventional Management

ObjectiveTo explore the comprehensive role of systemic endoscopic intervention in healing esophageal anastomotic leak.MethodsIn total, 3919 consecutive patients with esophageal cancer who underwent esophagectomy and immediate esophageal reconstruction were screened. In total, 203 patients (5.10%) diagnosed with anastomotic leakage were included. The participants were divided into three groups according to differences in diagnosis and treatment procedures. Ninety-four patients received conventional management, 87 patients received endoscopic diagnosis only, and the remaining 22 patients received systematic endoscopic intervention. The primary endpoint was overall healing of the leak after oncologic esophageal surgery. The secondary endpoints were the time from surgery to recovery and the occurrence of adverse events.Results173 (85.2%; 95% CI, 80.3-90.1%) of the 203 patients were successfully healed, with a mean healing time of 66.04 ± 3.59 days (median: 51 days; range: 13-368 days), and the overall healing rates differed significantly among the three groups according to the stratified log-rank test (P<0.001). The median healing time of leakage was 37 days (95% CI: 33.32-40.68 days) in the endoscopic intervention group, 51 days (95% CI: 44.86-57.14 days) in the endoscopic diagnostic group, and 67 days (95% CI: 56.27-77.73 days) in the conventional group. The overall survival rate was 78.7% (95% CI: 70.3 to 87.2%) in the conventional management group, 89.7% (95% CI: 83.1 to 96.2%) in the endoscopic diagnostic group and 95.5% (95% CI: 86.0 to 100%) in the systematic endoscopic intervention group. Landmark analysis indicated that the speed of wound healing in the endoscopic intervention group was 2-4 times faster at any period than that in the conservative group. There were 20 (21.28%) deaths among the 94 patients in the conventional group, 9 (10.34%) deaths among the 87 patients in the endoscopic diagnostic group and 1 (4.55%) death among the 22 patients in the endoscopic intervention group; this difference was statistically significant (Fisher exact test, P < 0.05).ConclusionTailored endoscopic treatment for postoperative esophageal anastomotic leakage based on endoscopic diagnosis is feasible and effective. Systematic endoscopic intervention shortened the treatment period and reduced mortality and should therefore be considered in the management of this disease.

757 AN APPROACH TO ACCELERATE HEALING AND SHORTEN THE HOSPITAL STAY OF PATIENTS WITH ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
KongJia Luo ◽  
KongJia Luo ◽  
JiuDi Zhong ◽  
ZiHui Tan ◽  
YiTong Wei ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Intervention Group ◽  
Healing Time ◽  
Endoscopic Diagnosis ◽  
Esophageal Reconstruction ◽  
Rank Test ◽  
Cancer Center ◽  
Endoscopic Intervention ◽  
Endoscopic Clipping ◽  
Treatment Procedures

Abstract   To explore the comprehensive role of systemic endoscopic intervention in healing esophageal anastomotic leak. To our knowledge, this paper is the first to discuss the outcome of anastomotic leaks and the association with healing time rather than whether the leak was fully healed. Methods In total, 3919 consecutive patients with esophageal cancer who underwent esophagectomy and immediate esophageal reconstruction between January 2012 and August 2019 at Sun Yat-Sen University Cancer Center were screened. In total, 203 patients (5.10%) diagnosed with postoperative anastomotic leakage were included. The participants were divided into three groups according to differences in diagnosis and treatment procedures. Ninety-four patients received conventional management, 87 patients received endoscopic diagnosis only, and the remaining 22 patients received systematic endoscopic intervention, including transnasal inner drainage, endoscopic fibrin glue repair and endoscopic clipping. The primary endpoint was overall healing of the leak after oncologic esophageal surgery. Results In total, 173 (85.2%; 95% CI, 80.3–90.1%) of the 203 patients were successfully healed, with a mean healing time of 64.42 ± 3.82 days (median: 51 days; range: 13 368 days), and the overall healing rates differed significantly among the three groups according to the stratified log-rank test (P < 0.001). The median healing time of leakage was 44 days (95% CI: 27.15–60.86 days) in the endoscopic intervention group, 51 days (95% CI: 44.86–57.14 days) in the endoscopic diagnostic group, and 66 days (95% CI: 58.09–73.91 days) in the conventional group. Conclusion Tailored endoscopic treatment for postoperative esophageal anastomotic leakage based on endoscopic diagnosis is feasible and effective. Systematic endoscopic intervention shortened the treatment period and reduced mortality and should therefore be considered in the management of this disease.

PS01.175: EVALUATION OF ASSOCIATIONS BETWEEN GASTRIC TUBE PREPARATION METHODS AND THE INCIDENCE OF CERVICAL ANASTOMOTIC LEAKAGE AFTER ESOPHAGECTOMY FOR THORACIC ESOPHAGEAL CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 99-99
Author(s):  
Yutaka Miyawaki ◽  
Hiroshi Sato ◽  
Sinich Sakuramoto ◽  
Koujun Okamoto ◽  
Shigeki Yamaguchi ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Multivariate Logistic Regression Analysis ◽  
Esophageal Reconstruction ◽  
Peripheral Blood Flow ◽  
Thoracic Esophageal Cancer ◽  
Preparation Methods ◽  
Brinkman Index ◽  
The Difference

Abstract Background In esophageal reconstruction, the gastric tube (GT) is superior in elevation and handiness of the maneuver; therefore, GT is most often selected as a reconstruction conduit. Although some leakages from esophagogastric anastomoses are induced by ischemic or congested peripheral blood flow in the reconstruction conduits, the association between the GT and the incidence of anastomotic leakage (AL) is unclear. Methods Between February 2013 and September 2017, 188 consecutive patients who underwent an esophagectomy with GT reconstruction were enrolled in this cohort study. We performed GT reconstructions using narrow gastric tubes (Gr.N) until May 2016, which is when we began preparing and using stretched GTs (Gr.S). We retrospectively evaluated the incidence of AL. Results AL occurred in 29 of 188 (15.4%) patients, and the frequency of AL occurrence in Gr.S was lower than that in Gr.N (P = 0.034). Sex, body mass index, Brinkman index, and presence of hypertension or anemia were significantly associated with AL (P = 0.033, 0.041, 0.003, 0.030, and 0.042, respectively). The multivariate logistic regression analysis suggested that the type of GT used and the Brinkman index were independent risk factors for AL (P = 0.016 and 0.020, respectively). Conclusion Our results demonstrated that the difference in the GT preparation method was an independent risk factor for AL after cervical esophagogastrostomy. We suggest that the method of GT preparation could contribute to a reduction of AL after esophagectomy. Disclosure All authors have declared no conflicts of interest.

scholarly journals Pectoralis Major Myocutaneous Flap Repair for Anastomotic Leakage after Esophageal Bypass Surgery

2021 ◽  
Vol 54 (11) ◽  
pp. 760-767
Author(s):  
Tomohiko Sasaki ◽  
Satoru Motoyama ◽  
Hiroshi Imano ◽  
Yusuke Sato ◽  
Ouki Yasui ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Bypass Surgery ◽  
Myocutaneous Flap ◽  
Pectoralis Major ◽  
Pectoralis Major Myocutaneous Flap ◽  
Flap Repair

Evaluation of the Associations between Gastric Tube Preparation Methods and the Incidence of Cervical Anastomotic Leakage after Esophagectomy for Thoracic Esophageal Cancer

2019 ◽  
Vol 37 (2) ◽  
pp. 154-162 ◽  
Author(s):  
Yutaka Miyawaki ◽  
Hiroshi Sato ◽  
Naoto Fujiwara ◽  
Hirofumi Sugita ◽  
Shinichi Sakuramoto ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Gastric Tube ◽  
Preparation Method ◽  
Multivariate Logistic Regression Analysis ◽  
Esophageal Reconstruction ◽  
Thoracic Esophageal Cancer ◽  
Preparation Methods ◽  
Brinkman Index ◽  
Flow Failure ◽  
Independent Risk Factors

Background: A gastric tube (GT) is most often selected as a reconstruction conduit in esophageal reconstruction. Although some leakage from esophagogastric anastomoses is induced by blood flow failure in reconstruction conduits, the association between the GT and the anastomotic leakage (AL) is unclear. Objectives: We retrospectively evaluated the incidence of AL according to the GT shape. Methods: Between February 2013 and September 2017, 188 consecutive patients who underwent esophagectomy with GT reconstruction were enrolled in this cohort study. We performed GT reconstruction using a narrow GT (Gr.N) until May 2016. Subsequently, we began preparing and using a stretched GT (Gr.S). Results: AL occurred in 29 of 188 (15.4%) patients. The frequency of AL was lower with Gr.S than with Gr.N (p = 0.034). Sex, body mass index, Brinkman index, hypertension, and anemia were significantly associated with AL (p = 0.033, 0.041, 0.003, 0.030, and 0.042, respectively). In a multivariate logistic regression analysis, the GT shape and the Brinkman index were shown to be independent risk factors for AL (p = 0.016 and 0.020, respectively). Conclusions: The GT preparation method is an independent risk factor for AL after cervical esophagogastrostomy. Thus, improved GT preparation methods could contribute to the reduction of AL after esophagectomy.

scholarly journals Subtotal stomach in esophageal reconstruction surgery achieves an anastomotic leakage rate of less than 1%

2020 ◽  
Vol 4 (4) ◽  
pp. 422-432
Author(s):  
Kazuhiro Yoshida ◽  
Yoshihiro Tanaka ◽  
Takeharu Imai ◽  
Yuta Sato ◽  
Yuji Hatanaka ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Leakage Rate ◽  
Esophageal Reconstruction ◽  
Reconstruction Surgery ◽  
Anastomotic Leakage Rate

The Comparisons of Three Stapler Placement Methods for Intrathoracic Mechanistic Circular Stapling in Ivor Lewis Minimally Invasive Esophagectomy

2021 ◽  
Author(s):  
Bo Zhang ◽  
Zi xiang Wu ◽  
Qi Wang ◽  
Sai Bo Pan ◽  
Lian Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Multivariable Analysis ◽  
Esophageal Reconstruction ◽  
Ivor Lewis ◽  
Anastomotic Complications ◽  
Invasive Esophagectomy ◽  
The Impact

Abstract Objectives: To analyze the impact of the reversal penetrating technique (RPT) for intrathoracic gastroesophageal mechanical anastomosis on the development of anastomotic complications in Ivor Lewis minimally invasive esophagectomy (ILMIE) and further identify the risk factors for the development of anastomotic leakage and stricture.Methods: A retrospective observational study was conducted using clinical data of 316 patients with esophageal carcinoma (EC) who underwent ILMIE from January 2012 to December 2019. The participants were divided into three groups of RPT, transoral Orvil technique (TOT), or purse-string technique (PST) according to the different stapler placenent methods for intrathoracic mechanistic circular stapling. Multivariable analysis was performed to investigate the association of risk factors with anastomotic leakage and stricture.Results: There were 154 patients with RPT, 78 with TOT and 84 with PST intrathoracic gastroesophageal circular stapling in ILMIE. There was no differences in intraoperative anastomosis related conditions inclouding conversion of open operations, ways of esophageal reconstruction, lymph nodes harvested between the three groups. Whereas, The mean total operative time, and gastroesophageal anastomosis time in the RPT group were significantly shorter than those in other groups (both p<0.05). The rates of anastomotic leakage and stricture showed no statistical differences between three groups, respectively (Leakage: p=0.941; Stricture: p=0.942). Multivariate analysis revealed that the PRT method of the anvil placement does not increase the probability of anastomotic leakage (PRT: reference; TOT: odds ratio(OR) 2.845, P=0.255; PST: OR 2.234, p=0.242) and stricture (PRT: reference; TOT: OR 1.976, P=0.556; PST: OR 1.872, p=0.284).Conclusions: The PRT method of the anvil placement for intrathoracic gastroesophageal circular stapling does not increase the risk of anastomotic complications in ILMIE, but had significantly shorter surgical time and anastomosis time.

Platelet Aggregability and the Occurrence of Anastomotic Leakage after Esophageal Reconstruction

1995 ◽  
Vol 8 (2) ◽  
pp. 141-146 ◽  
Author(s):  
Hiroyuki Kuwano ◽  
Kinya Baba ◽  
Masaru Morita ◽  
Shin-Ichi Tsutsui ◽  
Yasushi Toh ◽  
...  
Keyword(s):  
Anastomotic Leakage ◽  
Esophageal Reconstruction ◽  
Platelet Aggregability
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