The Role of Endoscopic Stent in Management of Postesophagectomy Leaks

Introduction Anastomotic leak is a dreaded complication following esophagectomy. Conventional management for leaks includes invasive reoperation and even gastrointestinal diversion. Objective The aim of this study was to examine our contemporary outcome of using endoscopic esophageal stenting as primary therapy for management of anastomotic leak following minimally invasive esophagectomy (MIE). Methods We reviewed data on 11 patients who developed an esophageal leak following 111 MIE between January 2011 and December 2019. Of the 11 anastomotic leaks, 10 patients had an anastomotic disruption and underwent endoscopic esophageal stenting as primary therapy for management of leaks, while 1 patient had an anastomotic disruption complicated by an associated tracheoesophageal fistula that required surgical reoperation and subsequent colonic interposition. Main outcome measures focused on the 10 patients who were managed with endoscopic stenting, including length of hospital stay following leak management, need for thoracotomy or gastrointestinal diversion for leak, stent complications, and leak-associated mortality. Results Of the 10 patients who underwent endoscopic esophageal stenting as primary therapy for management of leaks, there were 8 males with a median age of 66 years. The median time to diagnosis of anastomotic leak was 10 days postoperatively. One of the ten patients also underwent percutaneous drain placement, while none of the patients required thoracotomy. Median duration of stent placement was 39 (range, 29-105) days. Median length of stay after stent placement was 10 (range, 4-43) days. The median number of stent exchange was 1 (range, 1-3) stent. Gastrointestinal continuity was maintained in all patients. The 90-day leak-associated mortality was 9.1% (1 of 11 patients). Conclusions Endoscopic stenting is an effective primary therapy in the management of postesophagectomy leak and avoids the need for an invasive, reoperative thoracotomy or gastrointestinal diversion procedure.

COMPLICATED COURSE OF LATE PATIENT’S SURVIVAL AFTER THE CLASSIC BENTALL PROCEDURE WITH THE CABROL SHUNT

In the setting of bleeding into the perigraft space, the classic Bentall operation can be modified by the usage of the Cabrol shunt. This shunt is applied in order to drain the blood into the right atrium and it is expected to close gradually. Anastomotic suture line disruption along with concomitant blood flow into the perigraft space may rarely open the shunt and cause the right heart failure. Due to the anastomotic complications, the classic Bentall operation no longer is widely used in clinical practice, but patients who underwent such procedure some decades ago may be coping with various symptoms nowadays. In this article, the cases of anastomotic disruption as well as pseudoaneurysm formation and the opening of the Cabrol shunt 21 years after such kind of operation are presented. The patient underwent surgical repair and was confronted with the reoccurrence of the coronary pseudoaneurysm three years later.