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Surgery Today
Erschienen in: Surgery Today 3/2019

13.10.2018 | Review Article

Esophagojejunal anastomotic leakage following gastrectomy for gastric cancer

verfasst von: Rie Makuuchi, Tomoyuki Irino, Yutaka Tanizawa, Etsuro Bando, Taiichi Kawamura, Masanori Terashima

Erschienen in: Surgery Today | Ausgabe 3/2019

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Abstract

Esophagojejunal anastomotic leakage (EJAL) is a serious complication of total or proximal gastrectomy for gastric cancer, with a reported incidence of 2.1–14.6% and mortality of up to 50%. EJAL is an independent prognostic factor for the poor survival of gastric cancer patients. Meticulous surgical techniques, experience with anastomotic devices, and a thorough understanding of various risk factors and preventive measures are essential and early diagnosis is critical for preventing EJAL-related death. Patients with suspected EJAL must be evaluated promptly, but contrast swallow is not recommended. There is no standard treatment strategy for EJAL, although conservative treatment with drainage and nutritional support is the most common approach. Effective endoscopic treatments have been reported but need further validation. Surgical treatment is associated with high mortality but should be considered to prevent death from suboptimal EJAL management, for patients with severe sepsis or when conservative treatment has failed.
Literatur
1.
Japanese Gastric Cancer A. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20(1):1–19.CrossRef
2.
Isozaki H, Okajima K, Ichinona T, Hara H, Fujii K, Nomura E. Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer. Hepatogastroenterology. 1997;44(17):1509–12.PubMed
3.
Tonouchi H, Mohri Y, Tanaka K, Ohi M, Kobayashi M, Yamakado K, et al. Diagnostic sensitivity of contrast swallow for leakage after gastric resection. World J Surg. 2007;31(1):128–31.CrossRefPubMed
4.
Lang H, Piso P, Stukenborg C, Raab R, Jahne J. Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol. 2000;26(2):168–71.CrossRefPubMed
5.
Sauvanet A, Mariette C, Thomas P, Lozac’h P, Segol P, Tiret E, et al. Mortality and morbidity after resection for adenocarcinoma of the gastroesophageal junction: predictive factors. J Am Coll Surg. 2005;201(2):253–62.CrossRefPubMed
6.
Migita K, Takayama T, Matsumoto S, Wakatsuki K, Enomoto K, Tanaka T, et al. Risk factors for esophagojejunal anastomotic leakage after elective gastrectomy for gastric cancer. J Gastrointest Surg. 2012;16(9):1659–65.CrossRefPubMed
7.
Carboni F, Valle M, Federici O, Levi Sandri GB, Camperchioli I, Lapenta R, et al. Esophagojejunal anastomosis leakage after total gastrectomy for esophagogastric junction adenocarcinoma: options of treatment. J Gastrointest Oncol. 2016;7(4):515–22.CrossRefPubMedPubMedCentral
8.
Deguchi Y, Fukagawa T, Morita S, Ohashi M, Saka M, Katai H. Identification of risk factors for esophagojejunal anastomotic leakage after gastric surgery. World J Surg. 2012;36(7):1617–22.CrossRefPubMed
9.
Schietroma M, Cecilia EM, Carlei F, Sista F, De Santis G, Piccione F, et al. Prevention of anastomotic leakage after total gastrectomy with perioperative supplemental oxygen administration: a prospective randomized, double-blind, controlled, single-center trial. Ann Surg Oncol. 2013;20(5):1584–90.CrossRefPubMed
10.
El-Sourani N, Bruns H, Troja A, Raab HR, Antolovic D. Routine use of contrast swallow after total gastrectomy and esophagectomy: is it justified? Pol J Radiol. 2017;82:170–3.CrossRefPubMedPubMedCentral
11.
Lamb PJ, Griffin SM, Chandrashekar MV, Richardson DL, Karat D, Hayes N. Prospective study of routine contrast radiology after total gastrectomy. Br J Surg. 2004;91(8):1015–9.CrossRefPubMed
12.
Nomura S, Sasako M, Katai H, Sano T, Maruyama K. Decreasing complication rates with stapled esophagojejunostomy following a learning curve. Gastric Cancer. 2000;3(2):97–101.CrossRefPubMed
13.
Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg. 2014;260(6):1034–9.CrossRefPubMed
14.
Yoo HM, Lee HH, Shim JH, Jeon HM, Park CH, Song KY. Negative impact of leakage on survival of patients undergoing curative resection for advanced gastric cancer. J Surg Oncol. 2011;104(7):734–40.CrossRefPubMed
15.
Sierzega M, Kolodziejczyk P, Kulig J, Polish Gastric Cancer Study G. Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg. 2010;97(7):1035–42.CrossRefPubMed
16.
Kanaji S, Ohyama M, Yasuda T, Sendo H, Suzuki S, Kawasaki K, et al. Can the intraoperative leak test prevent postoperative leakage of esophagojejunal anastomosis after total gastrectomy? Surg Today. 2016;46(7):815–20.CrossRefPubMed
17.
Nishikawa K, Yanaga K, Kashiwagi H, Hanyuu N, Iwabuchi S. Significance of intraoperative endoscopy in total gastrectomy for gastric cancer. Surg Endosc. 2010;24(10):2633–6.CrossRefPubMed
18.
Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Poor survival rate in patients with postoperative intra-abdominal infectious complications following curative gastrectomy for gastric cancer. Ann Surg Oncol. 2013;20(5):1575–83.CrossRefPubMed
19.
Bonenkamp JJ, Songun I, Hermans J, Sasako M, Welvaart K, Plukker JT, et al. Randomised comparison of morbidity after D1 and D2 dissection for gastric cancer in 996 Dutch patients. Lancet. 1995;345(8952):745–8.CrossRefPubMed
20.
Cuschieri A, Fayers P, Fielding J, Craven J, Bancewicz J, Joypaul V, et al. Postoperative morbidity and mortality after D1 and D2 resections for gastric cancer: preliminary results of the MRC randomised controlled surgical trial. Surg Coop Group Lancet. 1996;347(9007):995–9.
21.
Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.CrossRefPubMed
22.
Takeuchi M, Ishii K, Seki H, Yasui N, Sakata M, Shimada A, et al. Excessive visceral fat area as a risk factor for early postoperative complications of total gastrectomy for gastric cancer: a retrospective cohort study. BMC Surg. 2016;16(1):54.CrossRefPubMedPubMedCentral
23.
Tokunaga M, Hiki N, Fukunaga T, Ogura T, Miyata S, Yamaguchi T. Effect of individual fat areas on early surgical outcomes after open gastrectomy for gastric cancer. Br J Surg. 2009;96(5):496–500.CrossRefPubMed
24.
Sugisawa N, Tokunaga M, Tanizawa Y, Bando E, Kawamura T, Terashima M. Intra-abdominal infectious complications following gastrectomy in patients with excessive visceral fat. Gastric Cancer. 2012;15(2):206–12.CrossRefPubMed
25.
Cancer Registry and Statistics. Cancer Infromation Service, National Cancer Center, Japan. 2016.
26.
Kitano S, Iso Y, Moriyama M, Sugimachi K. Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc. 1994;4(2):146–8.PubMed
27.
Uyama I, Sugioka A, Fujita J, Komori Y, Matsui H, Hasumi A. Laparoscopic total gastrectomy with distal pancreatosplenectomy and D2 lymphadenectomy for advanced gastric cancer. Gastric Cancer. 1999;2(4):230–4.CrossRefPubMed
28.
Kodera Y, Yoshida K, Kumamaru H, Kakeji Y, Hiki N, Etoh T, et al. Introducing laparoscopic total gastrectomy for gastric cancer in general practice: a retrospective cohort study based on a nationwide registry database in Japan. Gastric Cancer 2018.
29.
Katai H, Mizusawa J, Katayama H, Kunisaki C, Sakuramoto S, Inaki N, et al. Single-arm confirmatory trial of laparoscopy assisted total or proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group study JCOG1401. J Clin Oncol 2018;36 (suppl; abstr 4028).
30.
Hyung WJ, Yang HK, Han SU, Lee YJ, Park JM, Kim JJ, et al. A feasibility study of laparoscopic total gastrectomy for clinical stage I gastric cancer: a prospective multi-center phase II clinical trial, KLASS 03. Gastric Cancer 2018.
31.
Esrig BC, Frazee L, Stephenson SF, Polk HC Jr, Fulton RL, Jones CE. The predisposition to infection following hemorrhagic shock. Surg Gynecol Obstet. 1977;144(6):915–7.PubMed
32.
Marano L, Porfidia R, Pezzella M, Grassia M, Petrillo M, Esposito G, et al. Clinical and immunological impact of early postoperative enteral immunonutrition after total gastrectomy in gastric cancer patients: a prospective randomized study. Ann Surg Oncol. 2013;20(12):3912–8.CrossRefPubMed
33.
Tu RH, Lin JX, Zheng CH, Li P, Xie JW, Wang JB, et al. Development of a nomogram for predicting the risk of anastomotic leakage after a gastrectomy for gastric cancer. Eur J Surg Oncol. 2017;43(2):485–92.CrossRefPubMed
34.
Kikuchi H, Miyata H, Konno H, Kamiya K, Tomotaki A, Gotoh M, et al. Development and external validation of preoperative risk models for operative morbidities after total gastrectomy using a Japanese web-based nationwide registry. Gastric Cancer. 2017;20(6):987–97.CrossRefPubMedPubMedCentral
35.
Sato T, Aoyama T, Hayashi T, Segami K, Kawabe T, Fujikawa H, et al. Impact of preoperative hand grip strength on morbidity following gastric cancer surgery. Gastric Cancer. 2016;19(3):1008–15.CrossRefPubMed
36.
Lieffers JR, Bathe OF, Fassbender K, Winget M, Baracos VE. Sarcopenia is associated with postoperative infection and delayed recovery from colorectal cancer resection surgery. Br J Cancer. 2012;107(6):931–6.CrossRefPubMedPubMedCentral
37.
Peng PD, van Vledder MG, Tsai S, de Jong MC, Makary M, Ng J, et al. Sarcopenia negatively impacts short-term outcomes in patients undergoing hepatic resection for colorectal liver metastasis. HPB (Oxford). 2011;13(7):439–46.CrossRef
38.
Kawamura T, Makuuchi R, Tokunaga M, Tanizawa Y, Bando E, Yasui H, et al. Long-term outcomes of gastric cancer patients with preoperative sarcopenia. Ann Surg Oncol. 2018;25(6):1625–32.CrossRefPubMed
39.
Yang Z, Zhou X, Ma B, Xing Y, Jiang X, Wang Z. Predictive value of preoperative sarcopenia in patients with gastric cancer: a meta-analysis and systematic review. J Gastrointest Surg 2018.
40.
Hunt TK, Zederfeldt BH, Goldstick TK, Conolly WB. Tissue oxygen tensions during controlled hemorrhage. Surg Forum. 1967;18:3–4.PubMed
41.
Hooton TM, Haley RW, Culver DH, White JW, Morgan WM, Carroll RJ. The joint associations of multiple risk factors with the occurrence of nosocomial infection. Am J Med. 1981;70(4):960–70.CrossRefPubMed
42.
Hartmann M, Jonsson K, Zederfeldt B. Effect of tissue perfusion and oxygenation on accumulation of collagen in healing wounds. Randomized study in patients after major abdominal operations. Eur J Surg. 1992;158(10):521–6.PubMed
43.
Inokuchi M, Otsuki S, Ogawa N, Tanioka T, Okuno K, Gokita K, et al. Postoperative complications of laparoscopic total gastrectomy versus open total gastrectomy for gastric cancer in a meta-analysis of high-quality case-controlled studies. Gastroenterol Res Pract. 2016;2016:2617903.CrossRefPubMedPubMedCentral
44.
Etoh T, Honda M, Kumamaru H, Miyata H, Yoshida K, Kodera Y, et al. Morbidity and mortality from a propensity score-matched, prospective cohort study of laparoscopic versus open total gastrectomy for gastric cancer: data from a nationwide web-based database. Surg Endosc 2017.
45.
Inaba K, Satoh S, Ishida Y, Taniguchi K, Isogaki J, Kanaya S, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg. 2010;211(6):e25-9.CrossRefPubMed
46.
Usui S, Nagai K, Hiranuma S, Takiguchi N, Matsumoto A, Sanada K. Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument “Endo-PSI (II)” and circular stapler. Gastric Cancer. 2008;11(4):233–7.CrossRefPubMed
47.
Jeong O, Park YK. Intracorporeal circular stapling esophagojejunostomy using the transorally inserted anvil (OrVil) after laparoscopic total gastrectomy. Surg Endosc. 2009;23(11):2624–30.CrossRefPubMed
48.
Wang H, Hao Q, Wang M, Feng M, Wang F, Kang X, et al. Esophagojejunostomy after laparoscopic total gastrectomy by OrVil or hemi-double stapling technique. World J Gastroenterol. 2015;21(29):8943–51.CrossRefPubMedPubMedCentral
49.
Moisan F, Norero E, Slako M, Varas J, Palominos G, Crovari F, et al. Completely laparoscopic versus open gastrectomy for early and advanced gastric cancer: a matched cohort study. Surg Endosc. 2012;26(3):661–72.CrossRefPubMed
50.
Umemura A, Koeda K, Sasaki A, Fujiwara H, Kimura Y, Iwaya T, et al. Totally laparoscopic total gastrectomy for gastric cancer: literature review and comparison of the procedure of esophagojejunostomy. Asian J Surg. 2015;38(2):102–12.CrossRefPubMed
51.
Mariette C, De Botton ML, Piessen G. Surgery in esophageal and gastric cancer patients: what is the role for nutrition support in your daily practice? Ann Surg Oncol. 2012;19(7):2128–34.CrossRefPubMed
52.
Waitzberg DL, Saito H, Plank LD, Jamieson GG, Jagannath P, Hwang TL, et al. Postsurgical infections are reduced with specialized nutrition support. World J Surg. 2006;30(8):1592–604.CrossRefPubMed
53.
Valenzuela-Salazar C, Rojano-Rodriguez ME, Romero-Loera S, Trejo-Avila ME, Banuelos-Mancilla J, Delano-Alonso R, et al. Intraoperative endoscopy prevents technical defect related leaks in laparoscopic Roux-en-Y gastric bypass: a randomized control trial. Int J Surg. 2018;50:17–21.CrossRefPubMed
54.
Haverkamp L, Ruurda JP, van Hillegersberg R. Technical feasibility of TachoSil application on esophageal anastomoses. Gastroenterol Res Pract. 2015;2015:534080.CrossRefPubMedPubMedCentral
55.
Afaneh C, Abelson J, Schattner M, Janjigian YY, Ilson D, Yoon SS, et al. Esophageal reinforcement with an extracellular scaffold during total gastrectomy for gastric cancer. Ann Surg Oncol. 2015;22(4):1252–7.CrossRefPubMed
56.
Schuchert MJ, Abbas G, Nason KS, Pennathur A, Awais O, Santana M, et al. Impact of anastomotic leak on outcomes after transhiatal esophagectomy. Surgery. 2010;148(4):831–8 (discussion 8-40).CrossRefPubMed
57.
Bruce J, Krukowski ZH, Al-Khairy G, Russell EM, Park KG. Systematic review of the definition and measurement of anastomotic leak after gastrointestinal surgery. Br J Surg. 2001;88(9):1157–68.CrossRefPubMed
58.
Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992;111(5):518–26.PubMed
59.
Tokunaga M, Kondo J, Tanizawa Y, Bando E, Kawamura T, Terashima M. Postoperative intra-abdominal complications assessed by the Clavien–Dindo classification following open and laparoscopy-assisted distal gastrectomy for early gastric cancer. J Gastrointest Surg. 2012;16(10):1854–9.CrossRefPubMed
60.
Katai H, Mizusawa J, Katayama H, Takagi M, Yoshikawa T, Fukagawa T, et al. Short-term surgical outcomes from a phase III study of laparoscopy-assisted versus open distal gastrectomy with nodal dissection for clinical stage IA/IB gastric cancer: Japan Clinical Oncology Group Study JCOG0912. Gastric Cancer. 2017;20(4):699–708.CrossRefPubMed
61.
Aday U, Gundes E, Ciyiltepe H, Cetin DA, Gulmez S, Senger AS, et al. Examination of anastomotic leak with aqueous contrast swallow after total gastrectomy: should it be carried out routinely? Contemp Oncol (Pozn). 2017;21(3):224–7.
62.
Hogan BA, Winter DC, Broe D, Broe P, Lee MJ. Prospective trial comparing contrast swallow, computed tomography and endoscopy to identify anastomotic leak following oesophagogastric surgery. Surg Endosc. 2008;22(3):767–71.CrossRefPubMed
63.
Nederlof N, de Jonge J, de Vringer T, Tran TC, Spaander MC, Tilanus HW, et al. Does routine endoscopy or contrast swallow study after esophagectomy and gastric tube reconstruction change patient management? J Gastrointest Surg. 2017;21(2):251–8.CrossRefPubMed
64.
Page RD, Asmat A, McShane J, Russell GN, Pennefather SH. Routine endoscopy to detect anastomotic leakage after esophagectomy. Ann Thorac Surg. 2013;95(1):292–8.CrossRefPubMed
65.
Girard E, Messager M, Sauvanet A, Benoist S, Piessen G, Mabrut JY, et al. Anastomotic leakage after gastrointestinal surgery: diagnosis and management. J Visc Surg. 2014;151(6):441–50.CrossRefPubMed
66.
Messager M, Warlaumont M, Renaud F, Marin H, Branche J, Piessen G, et al. Recent improvements in the management of esophageal anastomotic leak after surgery for cancer. Eur J Surg Oncol. 2017;43(2):258–69.CrossRefPubMed
67.
Aryaie AH, Singer JL, Fayezizadeh M, Lash J, Marks JM. Efficacy of endoscopic management of leak after foregut surgery with endoscopic covered self-expanding metal stents (SEMS). Surg Endosc. 2017;31(2):612–7.CrossRefPubMed
68.
Hoeppner J, Kulemann B, Seifert G, Marjanovic G, Fischer A, Hopt UT, et al. Covered self-expanding stent treatment for anastomotic leakage: outcomes in esophagogastric and esophagojejunal anastomoses. Surg Endosc. 2014;28(5):1703–11.CrossRefPubMed
69.
Roy-Choudhury SH, Nicholson AA, Wedgwood KR, Mannion RA, Sedman PC, Royston CM, et al. Symptomatic malignant gastroesophageal anastomotic leak: management with covered metallic esophageal stents. AJR Am J Roentgenol. 2001;176(1):161–5.CrossRefPubMed
70.
Schubert D, Scheidbach H, Kuhn R, Wex C, Weiss G, Eder F, et al. Endoscopic treatment of thoracic esophageal anastomotic leaks by using silicone-covered, self-expanding polyester stents. Gastrointest Endosc. 2005;61(7):891–6.CrossRefPubMed
71.
Feith M, Gillen S, Schuster T, Theisen J, Friess H, Gertler R. Healing occurs in most patients that receive endoscopic stents for anastomotic leakage; dislocation remains a problem. Clin Gastroenterol Hepatol. 2011;9(3):202–10.CrossRefPubMed
72.
Aurello P, Magistri P, D’Angelo F, Valabrega S, Sirimarco D, Tierno SM, et al. Treatment of esophagojejunal anastomosis leakage: a systematic review from the last two decades. Am Surg. 2015;81(5):450–3.PubMed
73.
Fernandez A, Vila JJ, Vazquez S, Gonzalez-Portela C, de la Iglesia M, Lozano M, et al. Self-expanding plastic stents for the treatment of post-operative esophago-jejuno anastomosis leak. A case series study. Rev Esp Enferm Dig. 2010;102(12):704–10.CrossRefPubMed
74.
Tekinbas C, Erol MM, Akdogan R, Turkyilmaz S, Aslan M. Treatment of anastomotic leaks after esophagectomy with endoscopic hemoclips. J Thorac Cardiovasc Surg. 2009;137(3):766–7.CrossRefPubMed
75.
Lee S, Ahn JY, Jung HY, Lee JH, Choi KS, Kim DH, et al. Clinical outcomes of postoperative upper gastrointestinal leakage according to treatment modality. Dig Dis Sci. 2016;61(2):523–32.CrossRefPubMed
76.
Lee S, Ahn JY, Jung HY, Lee JH, Choi KS, Kim DH, et al. Clinical outcomes of endoscopic and surgical management for postoperative upper gastrointestinal leakage. Surg Endosc. 2013;27(11):4232–40.CrossRefPubMed
77.
Shim CN, Kim HI, Hyung WJ, Noh SH, Song MK, Kang DR, et al. Self-expanding metal stents or nonstent endoscopic therapy: which is better for anastomotic leaks after total gastrectomy? Surg Endosc. 2014;28(3):833–40.CrossRefPubMed
78.
Kim YJ, Shin SK, Lee HJ, Chung HS, Lee YC, Park JC, et al. Endoscopic management of anastomotic leakage after gastrectomy for gastric cancer: how efficacious is it? Scand J Gastroenterol. 2013;48(1):111–8.CrossRefPubMed
79.
Galizia G, Napolitano V, Castellano P, Pinto M, Zamboli A, Schettino P, et al. The Over-The-Scope-Clip (OTSC) system is effective in the treatment of chronic esophagojejunal anastomotic leakage. J Gastrointest Surg. 2012;16(8):1585–9.CrossRefPubMed
80.
Weiland T, Fehlker M, Gottwald T, Schurr MO. Performance of the OTSC System in the endoscopic closure of iatrogenic gastrointestinal perforations: a systematic review. Surg Endosc. 2013;27(7):2258–74.CrossRefPubMed
81.
Albert JG, Friedrich-Rust M, Woeste G, Strey C, Bechstein WO, Zeuzem S, et al. Benefit of a clipping device in use in intestinal bleeding and intestinal leakage. Gastrointest Endosc. 2011;74(2):389–97.CrossRefPubMed
82.
Kirschniak A, Subotova N, Zieker D, Konigsrainer A, Kratt T. The Over-The-Scope Clip (OTSC) for the treatment of gastrointestinal bleeding, perforations, and fistulas. Surg Endosc. 2011;25(9):2901–5.CrossRefPubMed
83.
Laukoetter M, Mennigen R, Neumann P, Dhayat S, Horst G, Palmes D, et al. Successful closure of defects in the upper gastrointestinal tract by endoscopic vacuum therapy (EVT): a prospective cohort study. Surg Endosc. 2017;31(6):2687–96.CrossRefPubMed
84.
Wedemeyer J, Schneider A, Manns MP, Jackobs S. Endoscopic vacuum-assisted closure of upper intestinal anastomotic leaks. Gastrointest Endosc. 2008;67(4):708–11.CrossRefPubMed
85.
Loske G, Schorsch T, Muller C. Endoscopic vacuum sponge therapy for esophageal defects. Surg Endosc. 2010;24(10):2531–5.CrossRefPubMed
86.
Wedemeyer J, Brangewitz M, Kubicka S, Jackobs S, Winkler M, Neipp M, et al. Management of major postsurgical gastroesophageal intrathoracic leaks with an endoscopic vacuum-assisted closure system. Gastrointest Endosc. 2010;71(2):382–6.CrossRefPubMed
87.
Kuehn F, Loske G, Schiffmann L, Gock M, Klar E. Endoscopic vacuum therapy for various defects of the upper gastrointestinal tract. Surg Endosc. 2017;31(9):3449–58.CrossRefPubMed
88.
Hwang J, Jeong Y, Park Y, Yoon H, Shin C, Kim N, et al. Comparison of endoscopic vacuum therapy and endoscopic stent implantation with self-expandable metal stent in treating postsurgical gastroesophageal leakage. Medicine. 2016;95(16):e3416-e.CrossRef
89.
Schardey HM, Joosten U, Finke U, Staubach KH, Schauer R, Heiss A, et al. The prevention of anastomotic leakage after total gastrectomy with local decontamination. A prospective, randomized, double-blind, placebo-controlled multicenter trial. Ann Surg. 1997;225(2):172–80.CrossRefPubMedPubMedCentral
Metadaten
Titel
Esophagojejunal anastomotic leakage following gastrectomy for gastric cancer
verfasst von
Rie Makuuchi
Tomoyuki Irino
Yutaka Tanizawa
Etsuro Bando
Taiichi Kawamura
Masanori Terashima
Publikationsdatum
13.10.2018
Verlag
Springer Singapore
Erschienen in
Surgery Today / Ausgabe 3/2019
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-018-1726-8

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Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

Radiusfraktur BDC Leitlinien Webinare
CME: 2 Punkte

Das Webinar beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

Appendizitis BDC Leitlinien Webinare
CME: 2 Punkte

Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.
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