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Ann Thorac Surg 1994;57:1229-1232
© 1994 The Society of Thoracic Surgeons

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Articles

Gastroesophageal leaks after antireflux operations

Department of Surgery, University of Alberta, Edmonton, Alberta, Canada

Accepted for publication August 26, 1993.

^_* Address reprint requests to Dr Urschel, Division of Thoracic Surgery, Roswell Park Cancer Institute, Elm and Carlton Sts, Buffalo, NY 14263-0001.

A retrospective review of gastroesophageal teaks complicating antireflux operations was conducted to determine the incidence, predisposing factors, optimal treatment, and outcome in such parents. Twelve postoperative gastroesophageal leaks occurred in a series of 1,005 antireflux procedures (1,2%), Four of the 12 patients had undergone a previous hiatal operation, and this was a significant risk factor for postoperative leak (p < 0.001). Ten of the 12 patients had undergone "incomplete" wraps that involved suturing of the gastric fundus to the esophagus, and this was a significant risk factor for postoperative leak (p < 0.04). Five patients had peritoneal contamination and 7 had mediastinal or pleural soilage. Patients with peritoneal perforations were less likely to require intensive care unit admission than were patients with thoracic perforations (p < 0.05). Six of the 12 perforations were either well contained or well drained at the time of the diagnostic contrast study. All 6 of these patients responded to conservative treatment. The remaining 6 perforations were not contained at the time of diagnosis. Two of the affected patients initially received conservative treatment (1 death and 1 late empyema) and 4 were treated by operation (1 death). The mortality associated with gastroesophageal perforation was 17%. Contained perforations can be treated conservatively but noncontained perforations require early and aggressive surgical intervention.