Surgical treatment of cervical anastomotic leaks following esophageal reconstruction

Cervical anastomotic leaks occurring in the early postoperative period after esophageal reconstruction are life-threatening complications, with a mortality rate similar to that of intrathoracic leaks if the posterior wall of the anastomosis is affected. Prompt diagnosis and aggressive surgical treatment is vital. The surgical procedures commonly used are often inadequate or unsatisfactory because of the difficulties encountered in the subsequent reconstruction. Twelve patient with an early cervical anastomotic leak following elective esophageal surgery were treated using an original surgical technique which allows diversion and simple delayed reconstruction of the anastomosis without risk of late stricture. Uncontrolled mediastinal sepsis accounted for the three deaths of the series and occurred in patients with a leak of the posterior anastomotic wall in whom definitive surgical treatment was delayed.