Post esophagectomy complications
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Post esophagectomy complications
- 1. Dr Harsh Shah MS,FMAS, DNB, MCh(GI) Kaizen Hospital, Ahmedabad
- 16. ICD gone Too far
- 19. Respiratory complications following esophagectomy N Pneumonia % Reintubations % Ventilator Dependency % Bailey et al 2003 1777 21.4 16.2 21.8 Atkins et al 2004 379 15.8 6.1 4.7 Avendano et al 2002 61 32.8 19.7 19.7 Tandon et al 2001 168 17.8 NA 23.8
- 27. Conduit
- 29. Anastomotic leak rates following esophagectomy N Anastomotic leak rate % Merritt et al 2011 138 12.3 Seely et al 2010 52 9.6 Van Heijl et al 2010 607 10.7 Orringer et al 2007 2007 12.0 Briel et al 2004 393 10.9 Hulscher et al 2002 - - Transhiatal 106 16.0 Transthoracic 114 14.0
- 32. Cervical Thoracic Higher overall leak rate Lower leak rate Limited surrounding contaminations Risk of pleural and mediastinal soilage
- 40. Contrast leak
- 59. Rates of chylothorax following esophagectomy N Chylothorax Rate % Orringer et al 2007 2029 1.0 Atkins et al 2004 379 0.79 Avendano et al 2002 61 8.2 Merigliano et al 2000 1787 1.1 Bolger et al 1991 537 2.0
- 64. RLN injury following esophagectomy N RLN injury rate % Atkins et al 2004 379 2.1 Orringer et al 2007 - - Group I 1976-98 1063 7.0 Group II 1998-2006 944 2.0 Hulscher et al 2002 - - Transhiatal 106 21.0 Transthoracic 114 13.0 Gockel et al 2005 424 15.7
Hinweis der Redaktion
- -Great care should be taken to avoid inadvertent bruising, stretching, or cutting the recurrent nerve -Preparation of the stomach should be gentle and precise to minimize ischemia of the tip that will be used for the anastomosis. -The anastomosis is the crux of the operation, so no consideration should be spared in making it perfect, regardless of which technique is chosen. -Excessive fluid administration should be avoided, the patient’s body temperature should be kept normothermic, -I always place a jejunostomy tube for postoperative nutrition that allows early feeding, maintenance of muscle mass, and takes the pressure off patients to force-feed themselves until they have regained their appetite and food capacity.
- Poor case selection- middle third tumour, adherent to trachea
- Ischemia of tip of stomach & venous congestion due to compression by manubrium sterni, Narrow conduit, Trauma during mobilization