Protection of intrathoracic anastomoses using the pleural tent after Ivor-Lewis esophagectomy.

Purpose of the study. Description of a technical procedure to diminish the risk of spillage into mediastinum in case of leakage from an intrathoracic anastomosis after partial esophagectomy. Method. In Ivor-Lewis procedures for cancer of the middle or lower third of the esophagus, the esogastric anastomosis is slipped under the upper mediastinal pleura which is kept intact. From 1989 to 1997, this technique has been used in 43 consecutive patients (squamous carcinoma in 22, adenocarcinoma in 21). Three patients died postoperatively (7%) and complications (in 38%) were mostly pulmonary and cardiac. No anastomotic leak was detected on routine Gastrographin swallow performed on the 7th postoperative day. Three patients required dilation for stenosis. Discussion and conclusion. Subpleural blanketing of intrathoracic anastomoses after esophagectomy is safe and easy to do, and should help diminish the consequences of possible anastomotic leakage.