How to preserve the native or reconstructed esophagus after perforations or postoperative leaks: A multidisciplinary 15-year experience  

作　　者：Dania Nachira Giuseppe Calabrese Alessia Senatore Valerio Pontecorvi Khrystyna Kuzmych Claudia Belletatti Ivo Boskoski Elisa Meacci Alberto Biondi Federico Raveglia Vincenzo Bove Maria Teresa Congedo Maria Letizia Vita Gloria Santoro Leonardo Petracca Ciavarella Filippo Lococo Giovanni Punzo Angelo Trivisonno Francesco Petrella Federico Barbaro Cristiano Spada Domenico D'Ugo Ugo Cioffi Stefano Margaritora 

机构地区：[1]Department of General Thoracic Surgery,Fondazione Policlinico Universitario Agostino Gemelli-IRCCS,UniversitàCattolica del Sacro Cuore,Rome 00168,Italy [2]Digestive Endoscopy Unit,Fondazione Policlinico Universitario Agostino Gemelli-IRCCS,UniversitàCattolica del Sacro Cuore,Rome 00168,Italy [3]Digestive Endoscopy Unit,Fondazione Policlinico Universitario Agostino Gemelli IRCSS,UniversitàCattolica del Sacro Cuore di Roma,Center for Endoscopic Research Therapeutics and Training,Rome 00168,Italy [4]General Surgery Unit,Fondazione Policlinico Universitario Agostino Gemelli-IRCCS,Rome 00168,Italy [5]Department of Thoracic Surgery,IRCCS-San Gerardo dei Tintori,Monza 20900,Lombardy,Italy [6]Department of Surgery,Fondazione Policlinico Universitario Agostino Gemelli-IRCCS,Rome 00168,Italy [7]Department of Anesthesiology and Intensive Care Medicine,Fondazione Policlinico Universitario Agostino Gemelli-IRCCS,UniversitàCattolica del Sacro Cuore,Rome 00168,Lazio,Italy [8]Department of Plastic Surgery,Assunzione di Maria Santissima Clinic,Rome 00135,Italy [9]Department of Surgery,“Agostino Gemelli”University Hospital,Catholic University of Rome,Rome 00168,Italy [10]Department of Surgery,University of Milan,Milan 20122,Italy

出　　处：《World Journal of Gastrointestinal Surgery》2024年第11期3471-3483,共13页世界胃肠外科杂志（英文）

摘　　要：BACKGROUND Esophageal perforation or postoperative leak after esophageal surgery remain a life-threatening condition.The optimal management strategy is still unclear.AIM To determine clinical outcomes and complications of our 15-year experience in the multidisciplinary management of esophageal perforations and anastomotic leaks.METHODS A retrospective single-center observational study was performed on 60 patients admitted at our department for esophageal perforations or treated for an anastomotic leak developed after esophageal surgery from January 2008 to December 2023.Clinical outcomes were analyzed,and complications were evaluated to investigate the efficacy and safety of our multidisciplinary management based on the preservation of the native or reconstructed esophagus,when feasible.RESULTS Among the whole series of 60 patients,an urgent surgery was required in 8 cases due to a septic state.Fifty-six patients were managed by endoscopic or hybrid treatments,obtaining the resolution of the esophageal leak/perforation without removal of the native or reconstructed esophagus.The mean time to resolution was 54.95±52.64 days,with a median of 35.5 days.No severe complications were recorded.Ten patients out of 56(17.9%)developed pneumonia that was treated by specific antibiotic therapy,and in 6 cases(10.7%)an atrial fibrillation was recorded.Seven patients(12.5%)developed a stricture within 12 months,requiring one or two endoscopic pneumatic dilations to solve the problem.Mortality was 1.7%.CONCLUSION A proper multidisciplinary approach with the choice of the most appropriate treatment can be the key for success in managing esophageal leaks or perforations and preserving the esophagus.

关 键 词：Esophageal perforations Postoperative leak Endoscopic vacuum-assisted closure therapy Metal stent Endoscopic suture Lateral esophagostomy Autologous emulsified stromal vascular fraction 

分 类 号：R655.4[医药卫生—外科学]