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Ann Thorac Surg 2006;82:1857-1862
© 2006 The Society of Thoracic Surgeons

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Original Articles: General Thoracic

Use of Pedicled Omentum in Esophagogastric Anastomosis for Prevention of Anastomotic Leak

Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India

Accepted for publication May 31, 2006.

^_* Address correspondence to Dr Bhat, PB No. 1061, GPO, Srinagar 190001, Jammu and Kashmir, India. (Email: drmakbarbhat{at}yahoo.co.uk; drmakbarbhat{at}gmail.com).

BACKGROUND: Esophagogastrectomy for carcinoma of the esophagus is the standard surgical treatment for cure or palliation. Esophagogastric anastomotic leakage is a life-threatening postoperative complication, more so if the leakage occurs in the chest.

METHODS: A prospective, randomized study was conducted on 238 patients treated for carcinoma of the esophagus between January 2000 and January 2006. The study excluded 44 patients (18.49%) who were inoperable. The patients were assigned to two treatment groups of 97 each (A and B) according to a restricted permuted block randomization plan. Group A patients underwent esophagogastrectomy with wrapping of the pedicled omentum around the esophagogastric anastomosis. Group B patients underwent esophagogastrectomy without using the omental graft. An Ivor-Lewis type esophagogastrectomy (TTE) was done in 122 patients (62.89%) and a transhiatal esophagogastrectomy (THE) was done in 72 (37.11%).

RESULTS: Anastomotic leaks occurred in 3 group A patients (3.09%) and in 14 (14.43%) group B patients. In group A, 54 patients underwent THE and 43 had TTE, with anastomotic leakage in 2 (3.70%) and 1 (2.33%) patients, respectively. In group B, 48 patients had THE and 49 had TTE, with anastomotic leakage in 8 (16.26%) and 6 (12.24%), respectively. The difference in the incidence of leakage was statistically significant (p = 0.005). There was no complication related to the omental graft technique nor was there a significant difference in the mortality between the two groups.

CONCLUSIONS: The pedicled omental transposition for reinforcing the anastomotic suture line significantly reduces the incidence of leakage after esophagogastrectomy for carcinoma of the esophagus, thus decreasing the morbidity and mortality of the procedure.

Related Article

Invited commentary

Enders K.W. Ng and Anthony P.C. Yim
Ann. Thorac. Surg. 2006 82: 1862. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				N. Karaoglanoglu, A. Turyilmaz, and A. Eroglu Use of Pedicled Omentum and Endostaplers in Esophagogastric Anastomosis Ann. Thorac. Surg., June 1, 2007; 83(6): 2259 - 2260. [Full Text] [PDF]

				E. K.W. Ng and A. P.C. Yim Invited commentary Ann. Thorac. Surg., November 1, 2006; 82(5): 1862 - 1862. [Full Text] [PDF]