الفهرس 
Anatomy of the OesophagusOnly 14 pages are availabe for public view
Abstract
Esophagectomy is needed for a variety of esophageal disorders, the most common indication is cancer esophagus, however, it is needed in benign disorders as postcorrosive strictures & endstage achalasia with esophageal dilatation.
Anastomotic leakage is one of the most severe complications leading to significant morbidity and increased risk of mortality.
Leaks after esophagectomy have different manifestations and vary in clinical presentations & complications, ranging from local wound infections to life threatening sepsis.
Cervical leaks have higher incidence than their thoracic counterparts, but their clinical impact is less critical, because of the extra thoracic location without connection to the mediastinum.
Most of the leaks develop within 10 days following surgery.
Diagnosis of anastomotic leakage after esophagectomy can be difficult. Most surgeons use a contrast swallow routinely for patients within 1 week of the operation to confirm anastomotic healing then the patient is allowed to resume swallowing. Others rely on gradual introduction of oral fluids and solids with close clinical monitoring and only request the contrast swallow if leakage is suspected.
Several diagnostic modalities are available for Anastomotic leakage detection, including contrast swallow examination, computed tomography (CT) scan, and endoscopy.
Initial radiographic contrast swallow examination may fail to diagnose many of these leaks.
The management of anastomotic leaks is often selective based on patients’ clinical condition, site of leak, and extent of leak.
Early identification of leaks provides the best chance to minimize morbidity and mortality from this complication.
While some anastomotic leakages can be managed with conservative treatment including nil per os [NPO], antibiotics, gastric drainage, enteral or parenteral feeding, and percutaneous thoracic drainage, other anastomotic leaks need interventions such as endoscopic stent placement, endoscopic vacuum-assisted closure devices, or surgery.
A key issue is that there is no uniform method for treating patients with symptomatic postesophagectomy leakage.
During the past decade, the management of esophageal leaks have shifted increasingly toward a more conservative approach, including endoscopic procedures, such as fibrin-glue injections and the use of clips and covered, self-expanding stents to seal leakages.
Surgery is reserved for patients with non contained leak or in uncontrolled sepsis or after failure of conservative method.
Resurgery after esophageal leakage is associated with high morbidity & mortality.
Most cervical leaks tend to be managed successfully by conservative treatment while thoracic leaks more likely need an intervention either upper GI & stenting, radiological guided drains or resurgery.
There is progressive development of endoscopic techniques providing better alternative to surgery in cases with failed conservative management.
Endoscopic techniques include self-expandable stents, endoscopic vacuum therapy, stent-over-sponge therapy, clipping with the over-the-scope-clip (OTSC) system, suturing with overstitch, and the use of a sealant.
CONCLUSION
• Anastomotic leak after surgery for esophageal diseases can vary in location, onset time, size, and extent. For local management, personalized treatment should be decided based on patient’s particular situations.
• Cervical anastomosis leakage has less morbidity & mortality compared to thoracic anastomosis.
• Conservative treatment is safe and successful in many cases, in cervical leakage conservative management is effective in most cases.
• Stent implantation is an effective method with other emerging endoscopic techniques.
• Resurgery should be considered carefully and reserved to uncontrolled leakage or patients with failed conservative management.