EARLY DILATION IN THE TREATMENT OF ESOPHAGEAL DISRUPTION

Citation
Mb. Orringer et Jh. Lemmer, EARLY DILATION IN THE TREATMENT OF ESOPHAGEAL DISRUPTION, The Annals of thoracic surgery, 56(6), 1993, pp. 1432-1433
Citations number
2
Categorie Soggetti
Surgery
ISSN journal
00034975
Volume
56
Issue
6
Year of publication
1993
Pages
1432 - 1433
Database
ISI
SICI code
0003-4975(1993)56:6<1432:EDITTO>2.0.ZU;2-H
Abstract
During the past four years, 11 patients with disruption of esophageal continuity have received dilation therapy prior to the healing of the fistula. In 7 patients undergoing transhiatal esophagectomy with a cer vical esophagogastric anastomosis, anastomotic leaks within 2 to 13 da ys (average, 8 days) after operation were treated by drainage, bedside esophageal dilations to at least a 46F bougie, and supplemental jejun ostomy tube feedings. Bougienage was performed within 1 to 12 days (av erage, 6 days) of the diagnosis of a leak, and oral intake was not dis continued for more than 72 hours average. Fistula drainage stopped wit hin 1 to 12 days (average, 6 days) of dilation in all patients. Four p atients referred with chronic intrathoracic esophageal disruptions (2, middle third and 2, distal third) following resection of diverticula (2), esophageal dilation (1), and trauma from Harrington rods (1) were also treated successfully by drainage, esophageal dilation, or both. Periesophageal inflammation associated with an esophageal leak, esopha geal spasm due to local irritation, or relative anastomotic narrowing may all contribute to obstruction distal to an esophageal disruption a nd adversely affect spontaneous closure. Dilation of the leaking esoph agus is not dangerous if performed carefully and selectively, and in f act may promote healing of the injury.