Transgastric drainage of the perforated esophagus: our experiences over 10 years.

We first described the technique of transgastric drainage of esophageal injuries in 2008. The method establishes vacuum drainage of the lumen of the esophagus, while maintaining patency, effectively exteriorizing the perforation to allow healing. We summarize this technique and present our experiences from the largest published series of patients. Our unit has treated selected esophageal injuries with transgastric drainage for 10 years. Indications include perforations not amenable to primary repair and treatment failure following prior surgical intervention. A 36 French silastic chest drain is pulled through the abdominal and stomach wall and introduced into the esophagus so that it crosses the perforation. Gastropexy is performed. Mediastinal decontamination and drainage are performed as needed. Continuous suction of -10 cm water is applied. Leak resolution is assessed with weekly water-soluble swallows. For this retrospective observational study, we analyzed data for patients with esophageal perforation, between 2012 and 2022. Inpatient mortality and time to leak resolution were set as primary and secondary outcomes. Esophageal perforations were treated with transgastric drain in 35 patients, of whom 68% (n = 24) were men. Median age was 67 (26-84). Spontaneous perforations accounted for 60% (n = 21), 31% (n = 11) were iatrogenic and 6% (n = 2) were ischemic. Inpatient and 30-day mortality was 14% (n = 5). Among successful treatments, the median length to resolution of leak on imaging was 34.5 days (6-80). Transgastric drainage can successfully treat esophageal perforations, where primary repair is not feasible. The mortality rate of 14% and reduced morbidity compares favorably with other traditional methods of management for esophageal perforation.

The Early Changes in Emergency General Surgery Following Implementation of UK COVID-19 Policy: A Retrospective Cohort Study.

Introduction Coronavirus disease 2019 (COVID-19) has rapidly spread worldwide. On 23rd March 2020, the UK introduced measures in an effort to curb the disease spread. The aim of this study was to analyse the effect of government and Royal College measures on the general surgical take. Materials and methods A retrospective analysis of patients referred to the acute general surgical take between 2nd March 2020 and 5th April 2020, including acuity at the time of referral, management, and patient outcomes, was undertaken. Data fit into a 'pre-COVID measures' cohort (prior to 23rd March 2020) and a 'post-COVID measures' cohort (on or after 23rd March 2020). Results A total of 465 patient referrals were included. There was a decrease in admissions rate in the post-COVID measures' cohort (p=0.001), but with an increase in patient acuity with white cell count (WCC) (p=0.024) and C-reactive protein (CRP) (p=0.036). Laparoscopic surgery decreased (p=0.004); however, the proportion of patients having an operation remained constant. There was no increase in short-term morbidity and mortality or length of stay (LOS). Discussion The data suggests that UK lockdown introduction influenced people's behaviour. Fewer patients presented to the surgical take; however, these patients were of higher acuity. Despite changes in royal college guidelines, there was no decrease in the proportion of patients undergoing operations; however, a higher proportion were open procedures. The change in national and college guidelines did not affect short-term morbidity, mortality or LOS.