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An Ivor Lewis Esophagectomy Designed to Minimize Anastomotic Complications and Optimize Conduit Function
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Delay in Oral Feeding is Associated With a Decrease in Anastomotic Leak Following Transhiatal Esophagectomy.

James E Speicher1, Tyler M Gunn2, Nicholas P Rossi3

  • 1Department of Cardiovascular Sciences, East Carolina University Brody School of Medicine, Greenville, North Carolina.

Seminars in Thoracic and Cardiovascular Surgery
|September 7, 2018
PubMed
Summary
This summary is machine-generated.

Delaying oral intake after transhiatal esophagectomy significantly reduced cervical anastomotic leaks and strictures. This protocol change improved patient outcomes, lowering complication rates for this major surgery.

Keywords:
delayed oral feedingesophageal anastomotic leaktranshiatal esophagectomy

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Area of Science:

  • Gastroenterology and Surgical Oncology
  • Esophageal Surgery and Surgical Complications

Background:

  • Cervical anastomotic leak is a frequent and serious complication following transhiatal esophagectomy.
  • Anastomotic leaks can lead to chronic strictures in up to 50% of patients, impacting long-term outcomes.
  • Current protocols often resume oral intake early, potentially increasing leak and stricture risks.

Purpose of the Study:

  • To evaluate the impact of delaying postoperative oral intake on the rate of cervical anastomotic leaks.
  • To assess the effect of delayed oral feeding on the incidence of anastomotic strictures after transhiatal esophagectomy.
  • To determine if modifying the postoperative feeding protocol improves overall patient outcomes.

Main Methods:

  • A retrospective study comparing two groups of patients undergoing elective transhiatal esophagectomy with cervical anastomosis.
  • Group 1 (early feeding): Oral intake resumed on postoperative day 3.
  • Group 2 (delayed feeding): Oral intake delayed until postoperative day 15.
  • Rates of anastomotic leak and stricture were compared between the two groups.

Main Results:

  • The rate of anastomotic leak significantly decreased from 14.5% in the early feeding group to 4.2% in the delayed feeding group (P = 0.0089).
  • A trend towards a lower rate of anastomotic stricture was observed in the delayed feeding group (15.8%) compared to the early feeding group (27.7%) (P = 0.05).
  • A total of 203 patients were analyzed, with 83 in the early group and 120 in the delayed group.

Conclusions:

  • Delaying the initiation of oral intake until 15 days postoperatively is associated with a significant reduction in cervical anastomotic leak rates.
  • Delayed oral feeding shows a trend towards decreasing the incidence of anastomotic strictures, improving long-term outcomes.
  • Modifying the postoperative feeding protocol represents a valuable strategy to enhance patient recovery and reduce complications after transhiatal esophagectomy.