Successful Treatment of a Major Leakage of an Esophagojejunal Anastomosis after Open Total Gastrectomy: A Case Report
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Keywords

Esophagojejunal Anastomosis
Total Gastrectomy
Anastomotic Leakage

How to Cite

1.
Eghlimi H, Rabbani A, Movahedi A. Successful Treatment of a Major Leakage of an Esophagojejunal Anastomosis after Open Total Gastrectomy: A Case Report. Surg Insights [Internet]. 2022 Apr. 3 [cited 2024 May 14];. Available from: https://mediterraneanjournals.com/index.php/si/article/view/593

Abstract

Esophagojejunal leakage is one of the most serious complications in total gastrectomy surgery for proximal gastric cancer anastomotic leakage after this procedure occurs despite improvements in surgical techniques. Although many cases of dehiscence due to the medical condition of the patient can be managed non-operatively, major leakage requires second or more surgery. It can seriously lead to death or major complications.
Case presentation
This report describes a 64-year-old man with a known case of proximal gastric adenocarcinoma, which underwent open total gastrectomy and esophagojejunal anastomosis. After the surgery, due to a major leak of anastomosis, which was diagnosed with oral gastrografin radiography pictures with patients fever and leukocytosis, the patient went to the operation room which at the second surgery esophagostomy and the jejunostomy feeding tube was inserted after six months esophagojejunotomy done and the patient tolerated the liquid and regular meals and was discharged.
Conclusion
Major leakage of an esophagojejunal anastomosis is a severe complication of total gastrectomy. Although if the patient s condition tolerates the morbidity of this complication, re-anastomosis after six months of leakage is possible. Therefore, aggressive and urgent reoperation and effective drainage are useful once it is diagnosed.

https://doi.org/10.55085/si.2022.593
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References

Aurello P, Magistri P, D'Angelo F, Valabrega S, Sirimarco D, Tierno SM, et al. Treatment of esophagojejunal anastomosis leakage: a systematic review from the last two decades. Am Surg. 2015;81(5);5:450-3. https://doi.org/10.1177%2F000313481508100523

Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc. 2005;61(7):891-6. https://doi.org/10.1016/s0016-5107(05)00325-1

Kataoka M, Masaoka A, Hayashi S, Honda H, Hotta T, Niwa T, et al. Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy. Ann Surg. 1989;209(1):99-104. https://doi.org/10.1097/00000658-198901000-00014

Isozaki H, Okajima K, Ichinona T, Hara H, Fujii K, Nomura E. Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer. Hepatogastroenterology. 1997;44(17):1509–12.

Lee S, Ahn JY, Jung HY, Lee JH, Choi KS, Kim DH, et al. Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage. Surg Endosc. 2013;27(11):4232-40. https://doi.org/10.1007/s00464-013-3028-y

Deguchi Y, Fukagawa T, Morita S, Ohashi M, Saka M, Katai H, et al. Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg. 2012;36(7):1617-22. https://doi.org/10.1007/s00268-012-1559-3

Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg. 2014;260(6):1034–9. https://doi.org/10.1097/sla.0000000000000781

Okabe H, Tsunoda S, Tanaka E, Hisamori S, Kawada H, Sakai Y. Is laparoscopic total gastrectomy a safe operation? A review of various anastomotic techniques and their outcomes. Surg Today. 2015;45(5):549-58. https://doi.org/10.1007/s00595-014-0901-9

Deguchi Y, Fukagawa T, Morita S, Ohashi M, Saka M, Katai H. Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg. 2012; 36(7):1617–22. https://doi.org/10.1007/s00268-012-1559-3

Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg. 2014;260(6):1034–9. https://doi.org/10.1097/sla.0000000000000781

Oka S, Sakuramoto S, Chuman M, Aratani K, Wakata M, Miyawaki Y, et al. Successful treatment of refractory complete separation of an esophagojejunal anastomosis after laparoscopic total gastrectomy: a case report. BMC Res Notes. 2017; 10(1):267. https://doi.org/10.1186/s13104-017-2589-6

Akashi Y, Hiki N, Nunobe S, Jiang X, Yamaguchi T. Safe management of anastomotic leakage after gastric cancer surgery with enteral nutrition via a nasointestinal tube. Langenbecks Arch Surg. 2012; 397(5): 737–44. https://doi.org/10.1007/s00423-012-0935-7

Deguchi Y, Fukagawa T, Morita S, Ohashi M, Saka M, Katai H. Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg 2012; 36: 1617–22. https://doi.org/10.1007/s00268-012-1559-3

Shoji Y, Nihei Z, Hirayama R, Mishima Y. Experiences with the linear cutter technique for performing Roux-en-Y anastomosis following total gastrectomy. Surg Today. 1995; 25(1): 27–31.

Kucukay F, Okten RS, Parlak E, Disibeyaz S, Ozogul Y, Bostanci EB, et al. Self-expanding covered metallic stent treatment of esophagojejunostomy fistulas. Abdom Imaging 2013; 38: 244–8. https://doi.org/10.1007/s00261-012-9895-1

Migita K, Takayama T, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T, et al. Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. J Gastrointest Surg. 2012; 16(9): 1659–65. https://doi.org/10.1007/s11605-012-1932-4

Oh SJ, Choi WB, Song J, Hyung WJ, Choi SH, Noh SH. Complications requiring reoperation after gastrectomy for gastric cancer: 17 Years experience in a single institute. J Gastrointest Surg. 2009; 13(2): 239-45. https://doi.org/10.1007/s11605-008-0716-3

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