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Complications - Esophageal resection

general and visceral surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Intraoperative complications

    • Splenic hemorrhage requires splenectomy
    • Complete ischemia of the gastric tube requires gastrectomy and subsequent transposition of the colon for reconstruction
    • Oversew pulmonary fistulas and/or manage with Tachosil® collagen sponge and/or fibrin sealant
    • Oversew any bleeding from the aorta or pulmonary vessels
    • Best prevent lymph fistulas by carefully suture ligating 

  2. Postoperative complications

    Management of any complications is more successful the more experience hospitals have with these procedures. This explains the better results in so-called "high-volume hospitals". Furthermore, after thoracic epidural anesthesia, had been introduced, early extubation of the patient in the operating room is usually possible, and in view of the postoperative analgesia it provides, it allows optimal physiotherapy, thereby helping to prevent pulmonary complications.

    • Failure of the esophagogastrostomy: This may be demonstrated by endoscopy or upper GI series, if necessary. If the anastomosis is well drained via the chest tubes, failure only concerns a small part of the circumference, and the patient is not septic, non-surgical management may be initiated, including antibiotic regimen, endoluminal stenting, acid inhibitors and oral decontamination. In some cases, endoscopic procedures such as fibrin sealing can be effective.

    In case of major anastomotic failure as well as in incipient sepsis, revision surgery is indicated, attempting de novoconstruction of the anastomosis, oversewing and transposing a pedicled muscle flap, or total resection of the gastric tube, cervical esophagostomy, and colon transposition as staged procedure.

    • Vocal fold paralysis (rather rare with this surgical technique): Tracheotomy and routine bronchial lavage in impaired expectoration
    • Partial atelectasis: Bronchoscopy and aspiration
    • Pneumonia: Sensitivity-guided antibiotics/antimycotics; respiratory exercises; tracheotomy, if necessary, with the option of routine bronchial lavage
    • Pleural effusions (septated): CT-guided drainage
    • Pancreatic fistula: Here, care should be taken to ensure adequate drainage, with the drainage being gradually withdrawn in the long run.
    • Ischemia of the transposed gastric tube: Resection of the gastric remnant, cervical esophagostomy, colon transposition as staged procedure