GASTROESOPHAGEAL LEAKS AFTER ANTIREFLUX OPERATIONS

A retrospective review of gastroesophageal leaks complicating antirefl ux operations was conducted to determine the incidence, predisposing f actors, optimal treatment, and outcome in such patients. Twelve postop erative gastroesophageal leaks occurred in a series of 1,005 antireflu x procedures (1.2%). Four of the 12 patients had undergone a previous hiatal operation, and this was a significant risk factor for postopera tive leak (p < 0.001). Ten of the 12 patients had undergone ''incomple te'' wraps that involved suturing of the gastric fundus to the esophag us, and this was a significant risk factor for postoperative leak (p < 0.04). Five patients had peritoneal contamination and 7 had mediastin al or pleural soilage. Patients with peritoneal perforations were less likely to require intensive care unit admission than were patients wi th thoracic perforations (p < 0.05). Six of the 12 perforations were e ither well contained or well drained at the time of the diagnostic con trast study. All 6 of these patients responded to conservative treatme nt. The remaining 6 perforations were not contained at the time of dia gnosis. Two of the affected patients initially received conservative t reatment (1 death and 1 late empyema) and 4 were treated by operation (1 death). The mortality associated with gastroesophageal perforation was 17%. Contained perforations can be treated conservatively but nonc ontained perforations require early and aggressive surgical interventi on.