TY - JOUR
T1 - Iatrogenic esophageal injuries
T2 - Evidence-based management for diagnosis and timing of contrast studies after repair
AU - Ko, Ellen
AU - O-Yurvati, A. H.
PY - 2012/1
Y1 - 2012/1
N2 - Leakage from gastroesophageal repair is considered a major complication and is often associated with increased hospital stay, morbidity, and mortality. Management of these patients is variable among surgeons. Cases managed by the thoracic surgical service from March 1, 2010 to March 1, 2011 were retrospectively reviewed. Eight patients met criteria for inclusion: 4 were repaired primarily, 2 by debridement with diversion, and 2 by Ivor- Lewis resection and reconstruction. Esophograms were completed between 1 and 7 days postoperatively. Of the 8 patients treated, there was 1 mortality (12%) due to fungal mediastinitis. Soluble contrast imaging revealed 2 leaks (25%), 1 contained and 1 diffuse, which was the only mortality. Changes in clinical status, even minor, require contrast imaging of the esophagus to assess repair integrity. Timing of contrast study is variable in the literature, averaging 5 to 14 days. A conservative time frame is 7 days, unless any clinical suspicion of an esophageal leak exists.
AB - Leakage from gastroesophageal repair is considered a major complication and is often associated with increased hospital stay, morbidity, and mortality. Management of these patients is variable among surgeons. Cases managed by the thoracic surgical service from March 1, 2010 to March 1, 2011 were retrospectively reviewed. Eight patients met criteria for inclusion: 4 were repaired primarily, 2 by debridement with diversion, and 2 by Ivor- Lewis resection and reconstruction. Esophograms were completed between 1 and 7 days postoperatively. Of the 8 patients treated, there was 1 mortality (12%) due to fungal mediastinitis. Soluble contrast imaging revealed 2 leaks (25%), 1 contained and 1 diffuse, which was the only mortality. Changes in clinical status, even minor, require contrast imaging of the esophagus to assess repair integrity. Timing of contrast study is variable in the literature, averaging 5 to 14 days. A conservative time frame is 7 days, unless any clinical suspicion of an esophageal leak exists.
KW - Esophagus
KW - Esophogram
KW - Perforation
UR - http://www.scopus.com/inward/record.url?scp=84871242098&partnerID=8YFLogxK
U2 - 10.9738/CC73.1
DO - 10.9738/CC73.1
M3 - Review article
C2 - 23101993
AN - SCOPUS:84871242098
SN - 0020-8868
VL - 97
SP - 1
EP - 5
JO - International Surgery
JF - International Surgery
IS - 1
ER -