[Temporary closure of interposed intestine in treatment of anastomotic dehiscence in esophageal surgery]

Abstract

Introduction: Though resections of the esophagus are performed today with a mortality of below 10% anastomotic leakages still represent a serious threat especially when located intrathoracically.

Methods: In cases with intrathoracic leakage and severe septic disease the interposed intestinum was interrupted by staples within the abdomen in order to inhibit bile and intestinal reflux to the anastomosis. Care was taken not to hurt the mesentery.

Results: Of 102 patients with adenocarcinoma of the gastroesophageal junction and the distal esophagus 48 were treated with cervical anastomosis and stomach or colon interposition. Anastomotic leakages occurred in 12.5% of cases and were cured without special measures. In 54 patients an intrathoracic anastomosis was done using small intestine or colon for interposition. Four cases (7.4%) with anastomotic leakage and severe septic disease were recorded. In these patients the interposed intestine was interrupted. The anastomotic leakage healed. With small intestine interposition a spontaneous reopening of the staples was observed after 6 weeks. Total mortality up to the time of discharge in 102 patients was 2%. No patient died because of anastomotic leakage.

Conclusions: With the method of interruption of the interposed intestine anastomotic leakages in esophageal surgery can be cured. The effect is based on the prevention of intestinal reflux to the anastomosis. With small intestine interposition a spontaneous reopening of the interruption can be expected after 6 weeks.