Etiology and treatment of intra thoracic gastric perforation after esophageal reconstruction with stomach / 中华胸心血管外科杂志

ABSTRACT

Objective To investigate the etiological factors and treatment of thoraco-gastric perforation (TGP) after esophagogastrostomy. Methods Retrospective analysis was carried out in 16 patients with thoraco-gastric perforation after esophagogastrostomy in our department from March 1974 to March 2004. The etiological factor, clinical feature, experiment test and the method of treatment were compared between TGP and patients of thoracic esophageal anastomosis leak (TEAL). Results Thoraco-gastric perforation occurs within 2～5 days postoperatively. Among these 16 cases, in 8, local necrosis of gastric wall was found which was caused by severe contusion and massive ligature. In 5, were penetrative injury of gastric wall caused by suture needle. In 3,unsuitable purse-string suturing of corner of greater or lisser gastric curvature. Hydropneumothorax occurred after thoraco-gastric perforation. Chest fluid was brown and turbid with putrefactive odor. With medium examination, anastomosis was normal, but medium and air bubbles were found outside of the stomach. Perforation were repaired and covered by pedicle tissue-flap in all cases. 15 cases were cured with no sequence. Conclusion TGP after esophagectomy were correlated with technique of surgery. TGP often occurs early after esophagogastrostomy. Transthoracic repairing of TGP should be done as soon as possible. The healing ratio of reparation was about 93.8%.