Laparoscopic Approach for Esophagojejunal Anastomotic Leak in Patients Requiring Re-Look Intervention: How We Do It

Author Info

Hai T Bui Steven T F Chan

Corresponding Author

Steven T F Chan
Department of Surgery, Upper Gastrointestinal Surgery Unit, Western Health, Melbourne, Australia

A B S T R A C T

Background: Esophagojejunal anastomotic leak (EJAL) is a serious and often a life-threatening complication following total gastrectomy. There is no standard management strategy, and the optimal approach remains controversial. Whilst non-operative approach (with or without percutaneous drainage), endoscopic approach (stents, clips, and vacuum devices) is the preferred initial management, and there remains a subset of EJAL patients that require operative intervention because of the uncontrolled leak with sepsis and potential high mortality. Methods: We present early clinical results of a minimally invasive novel surgical technique (continuous suction isoperistaltic jejuno-esophagostomy tube, SIJET) to divert saliva and enteric secretions away from the anastomotic area thus creating a hypothesised concept of “no leak” scenario. The details of this technique are described and illustrated. Results: This is the first clinical report of a laparoscopic technique for insertion of SIJET in two patients with esophagojejunal anastomotic leaks managed successfully. Both patients had failed to progress on non-operative management because of the uncontrolled leak with sepsis. Conclusion: The absolute prerequisite for complete healing of an anastomotic leak is adequate drainage of undrained fluid collections and diversion of luminal fluid away from the anastomotic defect. Laparoscopic SIJET provides a minimally invasive option for the management of esophagojejunal leak following total gastrectomy in patients with uncontrolled leak with sepsis.

Article Info

Article Type

Research Article

Publication history

Received: Thu 04, Feb 2021
Accepted: Thu 18, Feb 2021
Published: Tue 09, Mar 2021

Copyright

© 2023 Steven T F Chan. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Hosting by Science Repository.
DOI: 10.31487/j.SCR.2021.03.01