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.