Role of self-expanding stents in the treatment of intrathoracic dehiscence after Ivor Lewis esophagectomy.

Autor: Ruiz de Angulo D; Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España. Electronic address: druizdeangulo@hotmail.com., Ortiz MÁ; Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España., Munitiz V; Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España., Martínez de Haro LF; Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España., Alberca F; Unidad de Endoscopias, Servicio de Medicina Interna del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España., Serrano A; Unidad de Endoscopias, Servicio de Medicina Interna del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España., Egea J; Unidad de Endoscopias, Servicio de Medicina Interna del Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España., Parrilla P; Unidad de Cirugía Esofagogástrica, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Virgen de la Arrixaca, El Palmar, Murcia, España.
Jazyk: English; Spanish; Castilian
Zdroj: Cirugia espanola [Cir Esp (Engl Ed)] 2018 Nov; Vol. 96 (9), pp. 555-559. Date of Electronic Publication: 2018 Jun 20.
DOI: 10.1016/j.ciresp.2018.05.004
Abstrakt: Introduction: The role that self-expanding stents play in the treatment of dehiscence after transthoracic esophagectomy is not well defined and controversial. Our aim is to describe the experience in a tertiary care hospital using these devices for treating dehiscence after Ivor Lewis esophagectomy.
Methods: Descriptive observational study of patients who suffered anastomotic dehiscence after a transthoracic esophagectomy, and especially those treated with stents, in the period between 2011-2016 at our hospital.
Results: Ten patients (11.8%) presented anastomotic dehiscence. Eight patients received stents, one of them died due to causes unrelated to the device. Stent migration was observed in one case, and the devices were maintained an average of 47.3 days. The stent was not effective only in one patient who suffered early dehiscence due to acute ischemia of the stomach. The two patients who did not receive stents died after reoperation.
Conclusions: Stents are safe and effective devices that did not associate mortality in our series. They are especially indicated in intermediate or late-onset dehiscence and in fragile patients. The use of stents, together with mediastinal and pleural drainage, avoid reoperations with morbidity and mortality. Therefore, stents should be part of the usual therapeutic arsenal for the resolution of most suture dehiscences after Ivor Lewis esophagectomy. Randomized prospective studies would help to more precisely determine the role played by these devices in the treatment of dehiscence after transthoracic esophagectomy.
(Copyright © 2018. Publicado por Elsevier España, S.L.U.)
Databáze: MEDLINE
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