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Postoperative Esophageal Leak Management using the Polyflex Esophageal Stent

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Objective:
Leak following esophageal anastamosis or perforation repair prolongs hospitalization, prevents oral hydration and nutrition and can produce localized infection or sepsis. This investigation reviews our experience treating postoperative esophageal leaks with the Polyflex esophageal stent.
Methods:
Over a thirty month period, patients with a postoperative esophageal leak were offered participation in a protocol using the Polyflex stent for leak occlusion. Excluded were patients with previously untreated esophageal perforation or esophageal malignancy. Stents were placed endoscopically utilizing general anesthesia and fluoroscopy. Adequate drainage of infected areas was also simultaneously achieved. Leak occlusion was confirmed by esophagram. Patients were followed until their stent was removed and their esophageal leak had resolved.
Results:
Twenty one patients had twenty seven stents placed for leak occlusion following esophagectomy (5), esophageal perforation (5), surgical (4) or endoscopic (2) anti-reflux procedure, and esophageal diverticulectomy (3) or myotomy (2). The mean interval between surgery and stent placement was 12 + 8 days (range, 3 to31). Occlusion of the leak occurred in twenty patients. One patient experienced a dehiscence of there surgical esophageal perforation repair requiring esophageal diversion. Stent migration requiring repositioning (3) or replacement (4) occurred in five patients (24%). Twenty stents (95%) were removed without residual leak (mean, 51 + 43 range, 15 - 175 days). One patient developed a stricture after stent removal which required endoscopic dilatation. One patient died from the rupture of an infected thoracic aortic graft following the re-operative repair of an aortic dissection complicated by esophageal perforation.
Conclusions:
The Polyflex esophageal stent is an effective method for occluding a postoperative esophageal leak. They rapidly eliminate soilage of the mediastinum, pleura and peritoneum, allow oral hydration and nutrition and are easily removable. These stents also offer an appealing alternative to traditional esophageal diversion and subsequent reconstruction in patients with a persistent esophageal leak.
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