Omental reinforcement of the thoracic esophagogastric anastomosis: An analysis of leak and reintervention rates in patients undergoing planned and salvage esophagectomy

Objective An uncontained thoracic anastomotic leak may cause severe morbidity or mortality. Thoracic transposition of an omental flap along with the gastric conduit may decrease leak incidence, severity, or need for reoperations after esophagectomy. Methods We identified 607 patients who underwent e...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2012-11, Vol.144 (5), p.1146-1151
Main Authors: Sepesi, Boris, MD, Swisher, Stephen G., MD, Walsh, Garrett L., MD, Correa, Arlene, PhD, Mehran, Reza J., MD, Rice, David, MD, Roth, Jack, MD, Vaporciyan, Ara, MD, Hofstetter, Wayne L., MD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anastomosis, Surgical - adverse effects
Anastomotic Leak - diagnosis
Anastomotic Leak - etiology
Anastomotic Leak - prevention & control
Anastomotic Leak - surgery
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Biological and medical sciences
Cardiology. Vascular system
Cardiothoracic Surgery
Chi-Square Distribution
Elective Surgical Procedures
Esophageal Neoplasms - surgery
Esophagectomy - adverse effects
Esophagectomy - methods
Female
Humans
Logistic Models
Male
Medical sciences
Middle Aged
Multivariate Analysis
Odds Ratio
Omentum - surgery
Pneumology
Reoperation
Retrospective Studies
Risk Assessment
Risk Factors
Salvage Therapy
Stomach - surgery
Stomach, duodenum, intestine, rectum, anus
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Surgery of the digestive system
Surgical Flaps - adverse effects
Texas
Time Factors
Treatment Outcome
Young Adult
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Summary:Objective An uncontained thoracic anastomotic leak may cause severe morbidity or mortality. Thoracic transposition of an omental flap along with the gastric conduit may decrease leak incidence, severity, or need for reoperations after esophagectomy. Methods We identified 607 patients who underwent esophagectomy with thoracic anastomosis between January 2001 and August 2011. All patients were studied for leak postoperatively. Four leak grades were defined, ranging from radiographic leak to conduit loss. Univariate and multivariate analyses were performed to identify variables associated with anastomotic leak. Results Omental reinforcement was used in 215 of 607 patients (35%). Anastomotic leak occurred in 51 of 607 patients (8.4%). Patients with omentum had a significantly lower (odds ratio [OR], 0.4; P  = .014) anastomotic leak rate (4.7%) compared with patients without omentum (10.5%). Salvage resections were performed in 69 patients and 23 (32%) received omentum; the leak rate with omentum was 4.6% compared with 15% without (OR, 0.27; P  = .24). Patients undergoing planned esophagectomy with omentum had a significantly lower leak rate than patients without omentum (4.7% vs 9.8%) (OR, 0.43; P  = .04). Reoperations to rescue an anastomotic leak (Grade 3) was less common with omentum (OR, 0.26; P  = .024). Multivariate analysis identified omental reinforcement (OR, 0.45; P  = .034) and surgeon (OR, 3.4; P  = .001) as variables predictive of an anastomotic leak. Conclusions Omental reinforcement of thoracic esophagogastric anastomoses decreases overall leak rate and need for reoperation. We recommend pedicled omental transposition to reinforce all thoracic anastomoses. Endoscopic evaluation of significant anastomotic leaks is still warranted.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2012.07.085