Treatment algorithm for postoperative upper gastrointestinal fistulas and leaks using combined Vicryl plug and fibrin glue

 

 Buy Article Permissions and Reprints

The incidence of clinically significant anastomotic leaks after upper gastrointestinal surgery is approximately 4 % – 20 %, and the associated mortality can be as high as 80 %. Depending on the clinical presentation, the treatment options are surgery, conservative treatment with external drainage, or endoscopic treatment. This report presents 39 cases of clinically apparent anastomotic leaks or fistulas after surgery for upper gastrointestinal cancers that were treated by endoscopy with insertion of fibrin glue alone (n = 24) or with a combination of Vicryl plug and fibrin glue (n = 15). Thirteen of the 15 patients who underwent Vicryl/fibrin treatments showed complete healing of the anastomotic leak or fistula after one to four sessions. Long-term follow-up results are presented. Postoperative upper gastrointestinal fistulas or anastomotic leaks can be managed successfully with low morbidity by means of endoscopic insertion of Vicryl mesh with fibrin glue, thereby avoiding repeated major surgery and its associated risks.

References

• 1 Urschel J D. Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review.  Am J Surg. 1995;  169 634-640
  CrossrefPubMedGoogle Scholar
• 2 Orringer M B. Complications of esophageal resection and reconstruction. In: Waldhausen JA, Orringer MB, eds Complications in cardiothoracic surgery. St. Louis; Mosby Year Book 1991: 354-369
  PubMedGoogle Scholar
• 3 Dumonceau J-M, Cremer M, Lalmand B, Devière J. Esophageal fistula sealing: choice of stent, practical management, and cost.  Gastrointest Endosc. 1999;  49 70-78
  CrossrefPubMedGoogle Scholar
• 4 Segalin A, Bonavina L, Lazzerini M. et al . Endoscopic management of inveterate esophageal perforations and leaks.  Surg Endosc. 1996;  10 928-932
  CrossrefPubMedGoogle Scholar
• 5 Cellier C, Landi B, Faye A. et al . Upper gastrointestinal tract fistulae: endoscopic obliteration with fibrin sealant.  Gastrointest Endosc. 1996;  44 731-733
  CrossrefPubMedGoogle Scholar
• 6 Groitl H, Horbach T. Endoscopic treatment of anastomosis insufficiency and perforation in the esophagus with fibrin glue.  Langenbecks Arch Chir Suppl Kongressbd. 1996;  113 753-754
  PubMedGoogle Scholar
• 7 Torre M, Chiesa G, Ravini M. et al . Endoscopic gluing of bronchopleural fistula.  Ann Thorac Surg. 1994;  58 901-902
  CrossrefPubMedGoogle Scholar
• 8 Willetts I E, Dudley N E, Tam P KH. Endoscopic treatment of recurrent tracheo-oesophageal fistulae: long-term results.  Pediatr Surg Int. 1998;  13 256-258
  CrossrefPubMedGoogle Scholar
• 9 Pross M, Manger T, Mirow I, Lippert H. Die Therapieoptionen postoperativer Fisteln am oberen Gastrointestinaltrakt.  Zentralbl Chir. 1999;  124 45-46
  PubMedGoogle Scholar
• 10 Pross M, Manger T, Reinheckel T. et al . Endoscopic treatment of clinically symptomatic leaks of thoracic esophageal anastomoses.  Gastrointest Endosc. 2000;  51 73-76
  CrossrefPubMedGoogle Scholar
• 11 Zmora O, Mizrahi N, Rotholtz N. et al . Fibrin glue sealing in the treatment of perineal fistulas.  Dis Colon Rectum. 2003;  46 584-589
  CrossrefPubMedGoogle Scholar
• 12 Lindenmann J, Matzi V, Porubsky C. et al . Self-expandable covered metal tracheal type stent for sealing cervical anastomotic leak after esophagectomy and gastric pull-up: pitfalls and possibilities.  Ann Thorac Surg. 2008;  85 354-356
  CrossrefPubMedGoogle Scholar
• 13 Kauer W KH, Stein H J, Dittler H-J, Siewert J R. Stent implantation as a treatment option in patients with thoracic anastomotic leaks after esophagectomy.  Surg Endosc. 2008;  22 50-53
  CrossrefPubMedGoogle Scholar
• 14 Tuebergen D, Rijcken E, Mennigen R. et al . Treatment of thoracic esophageal anastomotic leaks and esophageal perforations with endoluminal stents: efficacy and current limitations.  J Gastrointest Surg. 2008;  12 1168-1176
  CrossrefPubMedGoogle Scholar
• 15 Schubert D, Pross M, Nestler G. et al . Endoscopic treatment of mediastinal anastomotic leaks.  Zentralbl Chir. 2006;  131 369-375
  Article in Thieme ConnectPubMedGoogle Scholar

G. BöhmMD, FRCS 

Department of General Surgery
University Hospital RWTH Aachen

Pauwelsstr. 30
52074 Aachen
Germany

Fax: +49-241-8082417

Email: gboehm@ukaachen.de