000			03383nam a22004577a 4500
008			200709s20202020 xxu||||| |||| 00| 0 eng d
022			_a2072-1439
024			_a10.21037/jtd.2020.01.15 [doi]
024			_ajtd-12-03-1022 [pii]
024			_aPMC7139088 [pmc]
040			_aOvid MEDLINE(R)
099			_a32274171
245			_aManagement of anastomotic leaks after esophagectomy and gastric pull-up. [Review]
251			_aJournal of Thoracic Disease. 12(3):1022-1030, 2020 Mar.
252			_aJ. thorac. dis.. 12(3):1022-1030, 2020 Mar.
253			_aJournal of thoracic disease
260			_c2020
260			_fFY2020
265			_sppublish
266			_d2020-07-09
520			_aAnastomotic leak is one of the most feared complications of esophagectomy, leading to prolonged hospital stay, increased postoperative mortality, and additional cost both to the patient and the hospital. Historically, anastomotic leaks have been treated with several techniques including conservative measures, percutaneous or operative drainage, primary surgical repair with buttressing, T-tube drainage, or excision of the esophageal replacement conduit with end esophagostomy. With advances in treatment modalities, including endoscopic stenting, clips and suturing, endoluminal vacuum-assisted closure (EVAC), such leaks increasingly are being managed without operative re-intervention and with salvage of the esophageal replacement conduit. For the purposes of this review, we identified studies analyzing the management of postoperative leak after esophagectomy. We then compared the efficacy of the various newer modalities for closure of anastomotic leaks and gastric conduit defects. We found both esophageal stent and EVAC sponges are effective treatments for closure of anastomotic leak. The chosen treatment modality for salvage of the esophageal replacement conduit is entirely dependent on the patient's clinical status and the surgeon's preference and experience. Emerging endoscopic and endoluminal therapies have increased the armamentarium of tools the esophageal surgeon has to facilitate successful resolution of anastomotic leaks following esophagectomy with reconstruction. While some literature suggests that EVACs have a slightly superior result in conduit success, we question this endorsement as EVACs mostly are utilized for contained leaks, many of which may have healed with conservative measures. This poses a challenge as there is clearly a bias given patient selection. Copyright 2020 Journal of Thoracic Disease. All rights reserved.
546			_aEnglish
650			_aIN PROCESS -- NOT YET INDEXED
651			_aMedStar Washington Hospital Center
656			_aMedStar Georgetown University Hospital Residents
656			_aSurgery/General Surgery
656			_aSurgery/Thoracic Surgery
657			_aJournal Article
657			_aReview
700			_aFamiglietti, Amber
700			_aHamm, Margaret
700			_aHenderson, Hayley
700			_aKhaitan, Puja Gaur
700			_aLazar, John F
700			_aMalouf, Stefanie
700			_aMargolis, Marc
700			_aWatson, Thomas J J
790			_aFamiglietti A, Hamm M, Henderson H, Khaitan PG, Lazar JF, Malouf S, Margolis M, Watson TJ
856			_uhttps://dx.doi.org/10.21037/jtd.2020.01.15 _zhttps://dx.doi.org/10.21037/jtd.2020.01.15
942			_cART _dArticle
999			_c5165 _d5165