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How to preserve the native or reconstructed esophagus after perforations or postoperative leaks: A multidisciplinary 15-year experience

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World Journal of Gastrointestinal Surgery 2024年第11期16卷 3471-3483页

作者： Dania Nachira Giuseppe Calabrese Alessia Senatore Valerio Pontecorvi Khrystyna Kuzmych Claudia Belletatti Ivo Boskoski Elisa Meacci Alberto Biondi Federico Raveglia Vincenzo Bove Maria Teresa Congedo Maria Letizia Vita Gloria Santoro Leonardo Petracca Ciavarella Filippo Lococo Giovanni Punzo Angelo Trivisonno Francesco Petrella Federico Barbaro Cristiano Spada Domenico D'Ugo Ugo Cioffi Stefano Margaritora Department of General Thoracic Surgery Fondazione Policlinico Universitario Agostino Gemelli-IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli-IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCSSUniversitàCattolica del Sacro Cuore di RomaCenter for Endoscopic Research Therapeutics and TrainingRome 00168Italy General Surgery Unit Fondazione Policlinico Universitario Agostino Gemelli-IRCCSRome 00168Italy Department of Thoracic Surgery IRCCS-San Gerardo dei TintoriMonza 20900LombardyItaly Department of Surgery Fondazione Policlinico Universitario Agostino Gemelli-IRCCSRome 00168Italy Department of Anesthesiology and Intensive Care Medicine Fondazione Policlinico Universitario Agostino Gemelli-IRCCSUniversitàCattolica del Sacro CuoreRome 00168LazioItaly Department of Plastic Surgery Assunzione di Maria Santissima ClinicRome 00135Italy Department of Surgery “Agostino Gemelli”University HospitalCatholic University of RomeRome 00168Italy Department of Surgery University of MilanMilan 20122Italy

BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening *** optimal management strategy is still *** To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic *** A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December *** outcomes were analyzed,and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus,when *** Among the whole series of 60 patients,an urgent surgery was required in 8 cases due to a septic ***-six patients were managed by endoscopic or hybrid treatments,obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed *** mean time to resolution was 54.95±52.64 days,with a median of 35.5 *** severe complications were *** patients out of 56(17.9%)developed pneumonia that was treated by specific antibiotic therapy,and in 6 cases(10.7%)an atrial fibrillation was *** patients(12.5%)developed a stricture within 12 months,requiring one or two endoscopic pneumatic dilations to solve the *** was 1.7%.CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.

关键词： Esophageal perforations postoperative leak Endoscopic vacuum-assisted closure therapy Metal stent Endoscopic suture Lateral esophagostomy Autologous emulsified stromal vascular fraction

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