544 MANAGEMENT OF ACUTE ANASTOMOTIC COMPLICATIONS AFTER IVOR-LEWIS ESOPHAGECTOMY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Tomas Harustiak ◽  
Jiri Tvrdon ◽  
Alexandr Pazdro ◽  
Martin Snajdauf ◽  
Hana Faltova ◽  
...  
Keyword(s):  
Surgical Revision ◽  
Esophageal Stent ◽  
Individual Treatment ◽  
Vacuum Therapy ◽  
Type I ◽  
Primary Therapy ◽  
Ivor Lewis ◽  
Anastomotic Complications ◽  
Ivor Lewis Esophagectomy ◽  
Surgical Methods

Abstract   Anastomotic leak (AL) and conduit necrosis (CN) are among the most serious surgical complications after esophageal resection. Endoscopic, radiological and surgical methods are used in their treatment. The aim of this paper is to evaluate the results of the treatment of acute anastomotic complications after Ivor-Lewis esophagectomy in a single high-volume center. Methods We performed a retrospective audit of a consecutive cohort of 815 patients undergoing transthoracic esophagectomy with intrathoracic esophago-gastric anastomosis from 2005 to 2019. AL was graded according to Esophagectomy Complications Consensus Group recommendation. Results There were 79 patients with AL and 6 patients with CN (10%). AL type I, II and III was diagnosed in 33 (39%), 25 (29%) and 27 (32%) patients, respectively. Esophageal stent was used in 40 patients. Primary surgical revision (with/without stent insertion) was performed in 14 patients. Reoperation was necessary overall in 25 patients (29%). Seventeen patients (20%) ended-up with esophageal diversion. Treatment with esophageal stent was successful in 28/40 patients (70%). Endoscopic vacuum-therapy was successfully used in three patients for peristent leak after stent extraction. Mortality of severe AL (type II and III) was 10/52 patients (19%). Conclusion Successful management of acute anastomotic complications requires early diagnosis and an individual treatment approach with the use of endoscopic, radiological and surgical methods. The primary attempt for anastomosis preservation using esophageal stent is desirable. Considering the clinical condition and CT finding, we recommend not to hesitate with surgical revision with debridement and drainage of pleural cavity and mediastinum. If primary therapy fails, life-saving procedure is the esophageal diversion.

Treatment of anastomotic leak after Ivor Lewis esophagectomy

2020 ◽  
Vol 99 (10) ◽  
Keyword(s):  
Anastomotic Leak ◽  
Esophageal Stent ◽  
Vacuum Therapy ◽  
Type I ◽  
Primary Therapy ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Retrospective Audit ◽  
Surgical Methods ◽  
Al Treatment

Introduction: Anastomotic leak (AL) is one of the most serious surgical complications after esophagectomy. Endoscopic, radiological and surgical methods are used in the treatment of AL. The aim of this study was to retrospectively evaluate our therapeutic procedures and results of AL treatment after Ivor Lewis esophagectomy (ILE). Methods: Retrospective audit of all ILEs performed in the years 2005−2019. Evaluation of AL treatment results according to Esophagectomy Complication Consensus Group (ECCG) classification and according to the primary therapeutic procedure with a focus on the treatment with esophageal stent. Results: Out of 817 patients with ILE, AL was detected in 80 patients (9.8%): ECCG type I 33 (41%), type II 23 (29%) and type III 24 (30%) patients. Some 33 patients (41%) were treated conservatively. Esophageal stents were used in 39 patients (49%), of which 18 (23%) had concomitant percutaneous drainage and 17 (21%) were reoperated. Reoperation without a stent insertion was performed in 7 patients (9%). Esophageal diversion with cervical esophagostomy was performed in a total of 16 patients (20%). Esophageal stent treatment was successful in 24/39 patients (62%). Airway fistula occurred in 4 patients treated with stent (10%). Endoscopic vacuum therapy was successfully used in three patients after stent failure. Eight patients (10%) died as a result of AL. Mortality of AL type I, II and III was 0%, 4% and 29%. Conclusion: Successful treatment of AL requires an individual and multidisciplinary approach. The primary effort should aim to preserve anastomosis using endoscopic and radiological methods. In case of insufficient clinical effect, we recommend not to hesitate with reoperation. If primary therapy fails, the life-saving procedure is a cervical esophagostomy.

PS02.147: MANAGEMENT OF A SIMULTANEOUS HIGH ESOPHAGO-TRACHEAL FISTULA CAUSED BY ESOPHAGEAL STENT DUE TO ANASTOMOTIC LEAKAGE AFTER IVOR-LEWIS ESOPHAGECTOMY: A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 162-162
Author(s):  
Hannah Andrae ◽  
Thomas Musholt ◽  
Hauke Lang ◽  
Peter Grimminger
Keyword(s):  
Case Report ◽  
Anastomotic Leakage ◽  
Healing Process ◽  
Esophageal Stent ◽  
Neoadjuvant Radiochemotherapy ◽  
Carcinoma Of The Esophagus ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
First Choice ◽  
Cervical Surgery

Abstract Background Esophagotracheal perforation is a very severe complication. However, an esophagotracheal perforation caused due to an esophageal stent after anastomotic leakage after ivor-lewis resection, is even more complex and associated with high mortality. Therefore we present a case how we managed a high esophagotracheal perforation and anastomotic leakage after ivor-lewis resection of esophageal cancer, prior treated with neoadjuvant radiochemotherapy. Methods Case report A 71-year old patient was transferred to our center due to an esophagotracheal perforation at the proximal stent—and at 18–20 cm from the front teeth row. The stent had been placed due to anastomotic leakage after ivor-lewis resection. The patient's history began with a squamous cell carcinoma of the esophagus, treated with neoadjuvant radiochemotherapy and followed by ivor-lewis esophagectomy. She developed an anastomotic leakage, which was treated with an esophageal stent. This stent perforated and caused a fistula between the esophagus and the trachea. Results After transfer to our center, we performed a tracheotomia with a tubus blocked, distal of the esophagotracheal fistula, to prevent a respiratory insufficiency. We removed the dislocated stent and induced an endosponge therapy. A prolonged healing process lead to a step-by-step decrease of the anastomotic leakage. Finally, the semicircular hole could be supplied by a fibrin sealant. We resected the fistula via cervical surgery and placed a pectoralis muscle flap between trachea and esophagus. The surgery was performed under steady neuromonitoring control. The postoperative course was uncomplicated. The patient could be extubated with spontaneous breathing. Eleven days after surgery, the patient could be discharged fully enteralised. The stomach interponate could be kept. Half a year later, our patient shows up in our regular consultation, reporting no dysphagia. Conclusion Our experience with endosponge treatment suggests that this is the first choice for successful healing of anastomotic leakage after ivor-lewis resection. A stenting of the esophagus after finding an anastomotic leakage can be considered, but is associated with a risk of further complication. Disclosure All authors have declared no conflicts of interest.

Preemptive Endoluminal Vacuum Therapy to Reduce Morbidity after Minimally Invasive Ivor Lewis Esophagectomy

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Philip C. Müller ◽  
Bernhard Morell ◽  
Diana Vetter ◽  
Dimitri A. Raptis ◽  
Joshua R. Kapp ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Vacuum Therapy ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy

scholarly journals An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function

10.3791/59255 ◽  
2020 ◽  
Author(s):  
Neal K. Ramchandani ◽  
Kenneth A. Kesler ◽  
Jonathon D. Rogers ◽  
Nakul Valsangkar ◽  
Samatha M. Stokes ◽  
...  
Keyword(s):  
Ivor Lewis ◽  
Anastomotic Complications ◽  
Ivor Lewis Esophagectomy ◽  
Conduit Function

scholarly journals Gastric conduit perforation after Ivor Lewis esophagectomy successfully treated with endoscopic vacuum therapy (E-VAC): a case report

2020 ◽  
Vol 2020 (8) ◽  
Author(s):  
Selma Hetoja ◽  
Carlo Alberto De Pasqual ◽  
Valentina Mengardo ◽  
Jacopo Weindelmayer ◽  
Simone Giacopuzzi
Keyword(s):  
Gastric Conduit ◽  
Vacuum Therapy ◽  
Intestinal Surgery ◽  
Promising Technique ◽  
Ivor Lewis ◽  
Surgical Closure ◽  
Ivor Lewis Esophagectomy ◽  
First Case ◽  
Life Threatening ◽  
Endoscopic Vacuum Therapy

Abstract Gastric conduit perforation is a life-threatening complication after esophagectomy and currently there is no consensus about its optimal management. Endoscopic vacuum therapy (E-VAC) is a promising technique for the treatment of leaks and perforations after upper gastro-intestinal surgery. We report the case of a 65 years-old male patient who underwent an Ivor Lewis esophagectomy for esophago-gastric junction adenocarcinoma. He referred to our Emergency Department for septic shock and right hydropneumothorax. We performed an emergency thoracoscopy with intraoperative esophagogastroduodenoscopy which showed a pre-pyloric perforation of the gastric conduit. The perforation was initially treated with unsuccessful primary surgical closure and subsequently by means of E-VAC, firstly placed intraluminal and then intracavitary. With the latter technique, we assisted to a progressive clinical improvement until the definitive healing of the perforation. To our knowledge, this is the first case of a gastric tube perforation after esophagectomy successfully treated with E-VAC.

scholarly journals Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Michael Tachezy ◽  
Seung-Hun Chon ◽  
Isabel Rieck ◽  
Marcus Kantowski ◽  
Hildegard Christ ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Anastomotic Leak ◽  
Vacuum Therapy ◽  
Phase 2 ◽  
Anastomotic Leaks ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Endoscopic Vacuum Therapy ◽  
Eortc Qlq

Abstract Background Intrathoracic anastomotic leaks represent a major complication after Ivor Lewis esophagectomy. There are two promising endoscopic treatment strategies in the case of leaks: the placement of self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT). Up to date, there is no prospective data concerning the optimal endoscopic treatment strategy. This is a protocol description for the ESOLEAK trial, which is a first small phase 2 randomized trial evaluating the quality of life after treatment of anastomotic leaks by either SEMS placement or EVT. Methods This phase 2 randomized trial will be conducted at two German tertiary medical centers and include a total of 40 patients within 2 years. Adult patients with histologically confirmed esophageal cancer, who have undergone Ivor Lewis esophagectomy and show an esophagogastric anastomotic leak on endoscopy or present with typical clinical signs linked to an anastomotic leak, will be included in our study taking into consideration the exclusion criteria. After endoscopic verification of the anastomotic leak, patients will be randomized in a 1:1 ratio into two treatment groups. The intervention group will receive EVT whereas the control group will be treated with SEMS. The primary endpoint of this study is the subjective quality of life assessed by the patient using a systematic and validated questionnaire (EORTC QLQ C30, EORTC QLQ-OES18 questionnaire). Important secondary endpoints are healing rate, period of hospitalization, treatment-related complications, and overall mortality. Discussion The latest meta-analysis comparing implantation of SEMS with EVT in the treatment of esophageal anastomotic leaks suggested a higher success rate for EVT. The ESOLEAK trial is the first study comparing both treatments in a prospective manner. The aim of the trial is to find suitable endpoints for the treatment of anastomotic leaks as well as to enable an adequate sample size calculation and evaluate the feasibility of future interventional trials. Due to the exploratory design of this pilot study, the sample size is too small to answer the question, whether EVT or SEMS implantation represents the superior treatment strategy. Trial registration ClinicalTrials.gov NCT03962244. Registered on May 23, 2019. DRKS-ID DRKS00007941

Endoluminal management of benign bronchoesophageal fistula

2021 ◽  
Vol 14 (9) ◽  
pp. e245240
Author(s):  
Jessica E Wahi ◽  
Diana Rocco ◽  
Roy Williams ◽  
Fernando M Safdie
Keyword(s):  
Surgical Repair ◽  
Definitive Treatment ◽  
Vacuum Therapy ◽  
Mainstem Bronchus ◽  
Open Surgical Repair ◽  
Bronchoesophageal Fistula ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
The Ideal

The ideal management of bronchoesophageal fistulas is a debated topic. While open surgical repair remains the most definitive treatment, not all patients are fit for surgery. In this communication, we present a patient who developed a bronchoesophageal fistula 1 year after an Ivor Lewis esophagectomy that involved the native oesophagus and right mainstem bronchus. Endoluminal vacuum therapy was successful at closing this benign bronchoesophageal fistula.

Endoscopic Vacuum Therapy via Pharyngostomy: Novel Access for Management of Upper Gastrointestinal Defects

2021 ◽  
pp. 000313482110415
Author(s):  
Manuel Giraldo-Grueso ◽  
Nathan Bolton ◽  
Russell Brown
Keyword(s):  
Oral Intake ◽  
Morbidity Rate ◽  
Vacuum Therapy ◽  
Outpatient Management ◽  
Ivor Lewis ◽  
Mortality And Morbidity ◽  
Ivor Lewis Esophagectomy ◽  
Endoscopic Vacuum Therapy ◽  
Upper Gastrointestinal

Background Perforation and anastomotic leakage of the upper gastrointestinal tract (UGI) has a high mortality and morbidity rate. Recently, UGI leaks have been treated with endoscopic vacuum therapy (EVT). However, this technique traditionally requires multiple EVT changes and a prolonged and uncomfortable nasoenteric intubation. We describe our experience using EVT through a novel pharyngostomy access to manage UGI leaks. Methods We describe our development and implementation of EVT via a novel pharyngostomy access to treat a variety of UGI defects. Preoperative, perioperative, and postoperative data were analyzed. Results Six patients with UGI perforations or anastomotic leaks were treated with an EVT using a pharyngostomy access. The median age was 69 years (IQR 53-71). Four patients leaked after an Ivor Lewis esophagectomy, one after a robotic para-esophageal hernia repair, and another after a Roux en Y esophagojejunostomy. Defects were detected on a median of 11.5 days (IQR 3-21). Median values for the duration of the EVT therapy and the number of EVT changes were 19.5 days (IQR 14-31) and 7 (IQR 6.5-9), respectively. Four of the patients were discharged with an EVT in place and were successfully managed as outpatients. At a median follow-up of 8 months, two patients developed strictures. None of the patients required any surgical re-intervention, they tolerated oral intake, and all leakages were confirmed closed by imaging and endoscopy. Discussion Endoscopic vacuum therapy can be successfully managed through a pharyngostomy access, as described. This access is easy, comfortable, and reliable and allows for a transition to outpatient management.

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