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The Annals of Thoracic Surgery, Vol 42, 536-539, Copyright © 1986 by The Society of Thoracic Surgeons

ARTICLES

Early dilation in the treatment of esophageal disruption

MB Orringer and JH Lemmer

During the past four years, 11 patients with disruption of esophageal continuity have received dilation therapy prior to the healing of the fistula. In 7 patients undergoing transhiatal esophagectomy with a cervical esophagogastric anastomosis, anastomotic leaks within 2 to 13 days (average, 8 days) after operation were treated by drainage, bedside esophageal dilations to at least a 46F bougie, and supplemental jejunostomy tube feedings. Bougienage was performed within 1 to 12 days (average, 6 days) of the diagnosis of a leak, and oral intake was not discontinued for more than 72 hours average. Fistula drainage stopped within 1 to 12 days (average, 6 days) of dilation in all patients. Four patients referred with chronic intrathoracic esophageal disruptions (2, middle third and 2, distal third) following resection of diverticula (2), esophageal dilation (1), and trauma from Harrington rods (1) were also treated successfully by drainage, esophageal dilation, or both. Periesophageal inflammation associated with an esophageal leak, esophageal spasm due to local irritation, or relative anastomotic narrowing may all contribute to obstruction distal to an esophageal disruption and adversely affect spontaneous closure. Dilation of the leaking esophagus is not dangerous if performed carefully and selectively, and in fact may promote healing of the injury.

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