Fistulas following esophagogastric surgery - Current status and how to reduce them?
Seance of wednesday 17 april 2024 (Journée de Cancérologie : cancers oeso-gastriques)
DOI number : 10.26299/x0g5-t255/emem.2024.14.09
Abstract
Anastomotic fistula (AF) after esophagogastric surgery is one of the main complications dreaded by all esophagogastric surgeons. This complication is responsible for 50% of deaths after esophagectomy according to Ivor Lewis and occurs in 10 to 15% of cases in high-volume expert centers.
The difficulty in managing AF after esophagectomy lies firstly in diagnosing it. Literature data advocate for performing an opacified and injected CT scan, associated with upper digestive endoscopy in case of significant doubt. Serum CRP and amylase levels in the drain could improve the diagnostic performance of the fistula. Its management relies on a dynamic and aggressive approach through endoscopic, radiological, or surgical means. To limit these AF occurrences, reducing tension on the anastomosis and evaluating/optimizing gastric plasty vascularization seem crucial.
The difficulty in managing AF after esophagectomy lies firstly in diagnosing it. Literature data advocate for performing an opacified and injected CT scan, associated with upper digestive endoscopy in case of significant doubt. Serum CRP and amylase levels in the drain could improve the diagnostic performance of the fistula. Its management relies on a dynamic and aggressive approach through endoscopic, radiological, or surgical means. To limit these AF occurrences, reducing tension on the anastomosis and evaluating/optimizing gastric plasty vascularization seem crucial.