Management of the cervical esophagogastric anastomotic leak

During the past two decades, the cervical esophagogastric anastomosis (CEGA) has gained increased popularity. The morbidity of a cervical esophagogastric anastomotic leak is essentially a transient salivary fistula, while that of an intrathoracic anastomotic disruption is mediastinitis and sepsis which are associated with a mortality of 50%. Among 842 patients undergoing transhiatal esophagectomy, mobilization of the stomach through the posterior mediastinum in the original esophageal bed, and a cervical esophagogastric anastomosis, SS (10.4%) had an early postoperative cervical wound infection due either to an anastomotic leak (74 patients) or a leak at the site of a gastric suspension stitch (14 patients). Seventy-seven of these SS (88%) of the cervical leaks healed spontaneously after opening the neck wound completely at the bedside, irrigating the wound with swallowed water several times daily, packing the wound, and maintaining nutrition with jejunostomy tube feedings. In 11 patients (1.3%), there were major cervical anastomotic complications including gastric tip necrosis. cervical vertebral osteomyelitis, epidural abscess, internal jugular vein abscess with pulmonary microabscesses, and tracheo-esophagogastric anastomotic fistula. While serious complications after a properly performed cervical esophagogastric anastomosis are rare (1.3%), when they do occur, the results may be disastrous.