2 DECADES OF CERVICAL ESOPHAGOSTOMY - INDICATIONS AND OUTCOMES

Diverting cervical esophagostomy is a surgical procedure generally res erved for extremely ill patients as a life-saving maneuver. However, i t is also a procedure that is infrequently performed, such that most c enters have limited experience with the operation. To investigate the indications and outcomes of cervical esophagostomy, we reviewed the us e of this operation at UCLA Medical Center over the last 20 years as e mployed for esophageal leaks. Eighteen patients underwent this procedu re for the following indications: leak with malignant tracheoesophagea l fistula (11%), anastomotic leak (44%), endoscopic injury (18%), guns hot wound (5.5%), operative injury (11%), corrosive ingestion (11%), a nd spontaneous rupture (5.5%). Overall mortality directly attributable to sepsis was 33 per cent. Of the surviving patients, 67 per cent lat er underwent reconstruction. Seventy-two per cent of patients had end esophagostomies, and the remainder had loop diversions. The primary in dication for operation in these patients was persistent sepsis after i nitial surgical management of esophageal spillage into the mediastinum or neck. This series suggests that cervical esophagostomy, when appli ed to the appropriate patient population, can decrease mortality and a llow subsequent alimentary reconstruction.