Negative Pressure Therapy Versus Conventional Dressing for Management of Anastomotic Leak After Transhiatal Esophagectom
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ORIGINAL ARTICLE
Negative Pressure Therapy Versus Conventional Dressing for Management of Anastomotic Leak After Transhiatal Esophagectomy Monika Gureh 1 & Sanjay Gupta 1
&
Ashok K. Attri 1
Received: 23 June 2020 / Accepted: 9 October 2020 # Association of Surgeons of India 2020
Abstract Transhiatal esophagectomy (THE) with cervical esophagogastric anastomosis is done for esophageal carcinoma and various benign lesions of the esophagus. Cervical anastomotic (CA) leak following THE is a serious complication that adds significantly to morbidity. As these leaks usually manifest in neck, local wound care is one of the essential components to manage such leaks. This study aims to evaluate the effect of negative pressure therapy (NPT) on healing of cervical wound following CA leaks. The record of all patients, who underwent THE for benign or malignant lesion of the esophagus from 2012 to 2019, was retrospectively analyzed. Of all the patients who had CA leak, patients with type II CA leak were only included for further analysis. The outcome of the patients who received NPT for wound care was compared with those who received simple wound dressings in terms of time to oral feed, hospital stay, mortality, and dysphagia at 6 months. Seventy-two patients were thus identified and 18 (25%) had an anastomotic leak. Patients with type II leaks (n = 16) were successfully managed by conservative approach. NPT for wound care in these patients was associated with significant reduction in hospital stay and early resumption of oral intake (p < 0.05) as compared with simple wound dressings. Conservative approach is effective for management of CA leaks. NPT for wound care significantly reduces associated morbidity. Keywords Esophagectomy . Anastomotic leak . Negative pressure therapy
Introduction Mark Oringer in 1978 introduced the concept of transhiatal esophagectomy (THE) with cervical esophagogastric anastomosis for the patients who could not tolerate laparotomy and thoracotomy [1]. Current indications of THE include carcinoma esophagus, benign stricture secondary to corrosive injury or GERD, neuromuscular disorders, and Barrett’s esophagus with high-grade dysplasia. Advancement in surgical techniques and perioperative care has resulted in reduction in mortality but procedure is still associated with significant morbidity. Anastomotic dehiscence is one of the major concerns in these patients as it prolongs hospitalization and increases cost burden [2].
* Sanjay Gupta [email protected] 1
Department of Surgery, Government Medical College and Hospital, Chandigarh 160030, India
The incidence of leak following cervical anastomosis (CA) ranges from 10 to 25%. Treatment options include conservative management (local drainage, wound care, withholding oral diet, enteral or parenteral nutrition, gastric decompression, and antibiotics), endoscopic treatment (stents, clips, or endoscopic vacuum assisted closure), and surgery (complete anastomotic disruption with esophagostomy, gastrostomy, and delayed definitive reconstruction). However
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