PROTECTION OF INTRATHORACIC ANASTOMOSES U SING THE PLEURAL TENT AFTERIVOR-LEWIS ESOPHAGECTOMY

Purpose of the study. Description of a technical procedure to diminish the risk of spillage into mediastinum in case of leakage from an intr athoracic anastomosis after partial esophagectomy. Method. In Ivor-Lew is procedures for cancer of the middle or lower third of the esophagus , the esogastric anastomosis is slipped under the upper mediastinal pl eura which is kept intact. From 1989 to 1997, this technique has been used in 43 consecutive patients (squamous carcinoma in 22, adenocarcin oma in 21). Three patients died postoperatively (7%) and complications (in 38%) were mostly pulmonary and cardiac. No anastomotic leak was d etected on routine Gastrographin swallow performed on the 7th postoper ative day. Three patients required dilation for stenosis. Discussion a nd conclusion. Subpleural blanketing of intrathoracic anastomoses afte r esophagectomy is safe and easy to do, and should help diminish the c onsequences of possible anastomotic leakage.