Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma

Aims: The management of anastomotic leakage of the oesophago-jejunostomy af ter total gastrectomy for gastric carcinoma was evaluated in a retrospectiv e study. Patients and Methods: Over a 30-year period, a total of 1114 oesophago-jeju nostomies were performed during total gastrectomy for gastric cancer. In 83 cases (7.5%) a leak of the oesophago-jejunostomy was diagnosed. Results: Frequency of anastomotic leakage was independent of the type of re construction and of surgical radicality. Therapeutic management was conserv ative in 58 cases (69.9%), with placement of a naso-jejunal tube along the anastomoses and with percutaneous drainage of intraabdominal abscesses. In 25 patients re-operation with resuturing of the anastomoses or surgical dra inage of an abscess was performed. Mortality was 11/58 (19%) after conserva tive treatment of the anastomotic leakage and 16/25 (64%) after re-operatio n. Conclusion: Conservative management with a naso-intestinal tube and percuta neous drainage of intraabdominal abscesses is realistic for anastomotic lea ks. Re-operation results in a high morbidity and should only be considered when conservative management is not successful.