Management of Anastamotic Leak after Esophagectomy with Endoscopic Esophageal Stent

INTRODUCTION: A 59 year old male with a long history of barrett’s esophagus and previous nissen fundoplication underwent a laparoscopic, thoracoscopic Ivor Lewis Esophagectomy for esophageal carcinoma. Upper GI on POD # 9 showed a contained mediastinal leak measuring 3 x 4 cm.
METHODS: Endoscopy confirmed an anastamotic disruption. A pig tail drain was endoscopically placed and left for 72 hours. Subsequently a 22mm x 100mm covered removable esophageal stent was endoscopically deployed over the anastamosis and covering the defect.
RESULTS: A repeat upper GI study performed on post-stent day number 4 did not show any further evidence of leak. The total length of hospital stay was 21 days. The stent was subsequently removed approximately 4 months later without any further evidence of esophagogastric disruption.
CONCLUSION(S): Esophageal leak is a potentially catastrophic postoperative complication. For a contained leak, endoscopic esophgeal stent placement is a safe and effective alternative treatment to open operative repair.

Session: Podium Video Presentation

Program Number: V034

« Return to SAGES 2008 abstract archive