Management of esophagojejunal anastomosis leakage after total gastrectomy

Esophagojejunal anastomosis leakage (EAL) after total gastrectomy for gastric adenocarcinoma represents one of the most serious complications, with increased mortality rates and prolonged hospital stay after surgery. Treatment options include conservative management, endoscopic therapy, and surgery. The aim of the study was to present our experience in the management of this fatal complication.

From 2000 to 2016, we retrospectively reviewed all cases of EAL after total gastrectomy treated in our institution. The diagnosis of leakage was based on a combination of clinical and radiological findings. The type of treatment, postoperative stay, complications, cure, and mortality rates were analyzed.

EAL was diagnosed in 32 patients (9.5%), of whom 24 (75%) recovered with conservative therapy and two (6.2%) with OVESCO OTSC placement. The other six patients (18.8%) underwent surgery: two cases of abdominal drainage, two cases of primary repair, and two cases of reconstruction of anastomosis. Overall treatment was successful in 26 patients (81.2%) while mortality occurred in six cases (18.8%).

Conservative management of EAL is an option for clinically stable patients with small leakages with a high rate of cure. Re-operation results in a high mortality rate and should only be considered when conservative management is not successful or in very unstable patients.