[Surgical management of leak in an esophageal anastomosis]

The best management of anastomotic leaks is "prevention". In reconstruction of the esophagogastric anastomosis, special care should be taken to avoid injuring the vascular arcades between the right and left gastroepiploic arteries. Similarly in the colon interposition procedures, careful selection of the proper vascular pedicle is of basic importance, not only to avoid anastomotic leakage but to prevent gangrene of the conduit. If leakage occurs, initial management of small leaks includes decompression of the gastric tube or interposed colon pulled up, TPN and generally administration of antibiotics. For larger leaks, adequate drainage should be carried out and the necrotized, gastric tube or colonic segment should be removed immediately, and feeding jejiunostomy should be established. Free flap transfers of neovascularized jejunal segments were performed in three cases in our department with satisfactory postoperative course in order to repairer a chronic larger leaks (a partial defect of the gastric wall).