Therapy of anastomotic leak and its complications after extirpation of the oesophagus

Introduction: The incidence of the oesophago-gastric anastomotic leak on the neck region is about 2–25% percent in the literature. Generally it can close spontaneously without any treatment, but sometimes the long standing inflammation at anastomosis can make the leakage hardly heal, if persistent for a long time, strictures will eventually occur. Both situations will need some interventions, like operation or stent implantation.

Patients and Method: During the period 2000 to 2004, twenty-six patients required interventions because of anastomotic leak and stricture. Two patients were treated by stent implantation due to the un-healed leakage. Anastomosis closed without any interventions in other twenty-four patients, but nine of them (38%) has developed stricture in the line of the anastomosis after average of 2 months, therefore dilation with Savary-Gillard dilator were performed to all of them. In order to avoid the recurrence of the significant stricture, self-expandable stent were placed to five patients.

Results: Most of the patient has improved their symptom. In one patient, we realised that the mucosa became hypertrophied due to the pressure of the wire of the self-expandable stent; endoscopic loop resection was performed to remove the overgrowing tissue. During the endoscopic removal of the self-expandable stent, two patients had serious bleeding from the carotid artery, therefore emergency operations were needed. Three other patients were operated on and plastic corrections of the anastomosis were successfully performed.

Conclusions: Although the mortality of the neck anastomosis leakage after oesophagus resection is low, it still could cause serious complications which need complex minimal invasive or sometimes operative procedure. Dilator therapy could be useful in some of the patients. Since the complications could last for a long time and special attention must be paid to the hyperalimentation of the patients with feeding solution. Self-expandable stent implantation seems not to be the most suitable solution for the stricture of the anastomosis.