The Annals of Thoracic Surgery, Vol 57, 1229-1232, Copyright © 1994 by The Society of Thoracic Surgeons
Gastroesophageal leaks after antireflux operations
JD Urschel
Department of Surgery, University of Alberta, Edmonton, Canada.
A retrospective review of gastroesophageal leaks complicating antireflux
operations was conducted to determine the incidence, predisposing factors,
optimal treatment, and outcome in such patients. 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.
