The advantages of the cervical ultrasound examination during the conservative management of anastomotic leakage after hybrid McKeown esophagectomy
EAES Academy. Popa C. 07/05/22; 363164; P209
Dr. Călin Popa
Contributions
Contributions
Abstract
Aims:
The conservative treatment of anastomotic leakage from the cervical anastomosis after McKeown esophagectomy, is recognized as an efficient treatment option. Although, there is no standardized protocol recommended for conducting the conservative treatment of post-esophagectomy fistulas. Along with the conservative treatment, a careful monitorization is needed. We intend to emphasize through this study the advantages of the routine usage of seriate cervical ultrasound examinations during the conservative management program.
Methods:
Our study is an observational pilot single-center prospective study, that includes patients that underwent hybrid McKeown esophagectomy (thoracoscopic approach), performed by the same surgical team, in the year 2021. Eighteen cases have been identified. All patients have been followed postoperatively by cervical ultrasound. For the patients that developed anastomotic fistula, a standardized management program has been implemented, that included a daily follow-up using seriate cervical ultrasound examinations.
Results:
We have included 3 patients in our study, that developed cervical anastomotic leakage. The first two patients underwent a hybrid McKeown esophagectomy with reconstruction using the left colon, while the third patient underwent a hybrid McKeown esophagectomy with reconstruction using the gastric conduit. The patients developed the anastomotic fistula in postoperative days 6, 12 and 10, respectively. All patients followed the same standardized management protocol. The ultrasound examinations have been useful to monitor the dimensions of the perianastomotic collection (with its air and fluid components), and to view a day-to-day evolution that has not been apparent on clinico-biological parameters. We have been able to avoid unnecessary repetitive CT scans in all patients. The ultrasound evaluation has showed a favorable evolution in the first two patients, while in the third patient, the examination shifted the decision toward surgical intervention.
Conclusion:
Conservative treatment of cervical anastomotic leakage is a feasible option, but careful monitorization of the patient is warranted in order to determine the best timing for further interventions, when needed. The first results of our pilot study show that cervical ultrasound is an easy-to-use, bedside examination that should added to the standard conservative treatment of anastomotic fistula is commenced.
The conservative treatment of anastomotic leakage from the cervical anastomosis after McKeown esophagectomy, is recognized as an efficient treatment option. Although, there is no standardized protocol recommended for conducting the conservative treatment of post-esophagectomy fistulas. Along with the conservative treatment, a careful monitorization is needed. We intend to emphasize through this study the advantages of the routine usage of seriate cervical ultrasound examinations during the conservative management program.
Methods:
Our study is an observational pilot single-center prospective study, that includes patients that underwent hybrid McKeown esophagectomy (thoracoscopic approach), performed by the same surgical team, in the year 2021. Eighteen cases have been identified. All patients have been followed postoperatively by cervical ultrasound. For the patients that developed anastomotic fistula, a standardized management program has been implemented, that included a daily follow-up using seriate cervical ultrasound examinations.
Results:
We have included 3 patients in our study, that developed cervical anastomotic leakage. The first two patients underwent a hybrid McKeown esophagectomy with reconstruction using the left colon, while the third patient underwent a hybrid McKeown esophagectomy with reconstruction using the gastric conduit. The patients developed the anastomotic fistula in postoperative days 6, 12 and 10, respectively. All patients followed the same standardized management protocol. The ultrasound examinations have been useful to monitor the dimensions of the perianastomotic collection (with its air and fluid components), and to view a day-to-day evolution that has not been apparent on clinico-biological parameters. We have been able to avoid unnecessary repetitive CT scans in all patients. The ultrasound evaluation has showed a favorable evolution in the first two patients, while in the third patient, the examination shifted the decision toward surgical intervention.
Conclusion:
Conservative treatment of cervical anastomotic leakage is a feasible option, but careful monitorization of the patient is warranted in order to determine the best timing for further interventions, when needed. The first results of our pilot study show that cervical ultrasound is an easy-to-use, bedside examination that should added to the standard conservative treatment of anastomotic fistula is commenced.
Aims:
The conservative treatment of anastomotic leakage from the cervical anastomosis after McKeown esophagectomy, is recognized as an efficient treatment option. Although, there is no standardized protocol recommended for conducting the conservative treatment of post-esophagectomy fistulas. Along with the conservative treatment, a careful monitorization is needed. We intend to emphasize through this study the advantages of the routine usage of seriate cervical ultrasound examinations during the conservative management program.
Methods:
Our study is an observational pilot single-center prospective study, that includes patients that underwent hybrid McKeown esophagectomy (thoracoscopic approach), performed by the same surgical team, in the year 2021. Eighteen cases have been identified. All patients have been followed postoperatively by cervical ultrasound. For the patients that developed anastomotic fistula, a standardized management program has been implemented, that included a daily follow-up using seriate cervical ultrasound examinations.
Results:
We have included 3 patients in our study, that developed cervical anastomotic leakage. The first two patients underwent a hybrid McKeown esophagectomy with reconstruction using the left colon, while the third patient underwent a hybrid McKeown esophagectomy with reconstruction using the gastric conduit. The patients developed the anastomotic fistula in postoperative days 6, 12 and 10, respectively. All patients followed the same standardized management protocol. The ultrasound examinations have been useful to monitor the dimensions of the perianastomotic collection (with its air and fluid components), and to view a day-to-day evolution that has not been apparent on clinico-biological parameters. We have been able to avoid unnecessary repetitive CT scans in all patients. The ultrasound evaluation has showed a favorable evolution in the first two patients, while in the third patient, the examination shifted the decision toward surgical intervention.
Conclusion:
Conservative treatment of cervical anastomotic leakage is a feasible option, but careful monitorization of the patient is warranted in order to determine the best timing for further interventions, when needed. The first results of our pilot study show that cervical ultrasound is an easy-to-use, bedside examination that should added to the standard conservative treatment of anastomotic fistula is commenced.
The conservative treatment of anastomotic leakage from the cervical anastomosis after McKeown esophagectomy, is recognized as an efficient treatment option. Although, there is no standardized protocol recommended for conducting the conservative treatment of post-esophagectomy fistulas. Along with the conservative treatment, a careful monitorization is needed. We intend to emphasize through this study the advantages of the routine usage of seriate cervical ultrasound examinations during the conservative management program.
Methods:
Our study is an observational pilot single-center prospective study, that includes patients that underwent hybrid McKeown esophagectomy (thoracoscopic approach), performed by the same surgical team, in the year 2021. Eighteen cases have been identified. All patients have been followed postoperatively by cervical ultrasound. For the patients that developed anastomotic fistula, a standardized management program has been implemented, that included a daily follow-up using seriate cervical ultrasound examinations.
Results:
We have included 3 patients in our study, that developed cervical anastomotic leakage. The first two patients underwent a hybrid McKeown esophagectomy with reconstruction using the left colon, while the third patient underwent a hybrid McKeown esophagectomy with reconstruction using the gastric conduit. The patients developed the anastomotic fistula in postoperative days 6, 12 and 10, respectively. All patients followed the same standardized management protocol. The ultrasound examinations have been useful to monitor the dimensions of the perianastomotic collection (with its air and fluid components), and to view a day-to-day evolution that has not been apparent on clinico-biological parameters. We have been able to avoid unnecessary repetitive CT scans in all patients. The ultrasound evaluation has showed a favorable evolution in the first two patients, while in the third patient, the examination shifted the decision toward surgical intervention.
Conclusion:
Conservative treatment of cervical anastomotic leakage is a feasible option, but careful monitorization of the patient is warranted in order to determine the best timing for further interventions, when needed. The first results of our pilot study show that cervical ultrasound is an easy-to-use, bedside examination that should added to the standard conservative treatment of anastomotic fistula is commenced.
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