Repair using the pectoralis major muscle flap for anastomotic leakage after esophageal reconstruction via the subcutaneous route

Masaru Morita, Keisuke Ikeda, Masahiko Sugiyama, Hiroshi Saeki, Akinori Egashira, Keiji Yoshinaga, Eiji Oki, Noriaki Sadanaga, Yoshihiro Kakeji, Junichi Fukushima, Yoshihiko Maehara

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Anastomotic leakage with an intractable cutaneous fistula frequently develops after an esophagectomy and reconstruction via the subcutaneous route. Methods: A pectoralis major muscle (PMM) flap was used for the treatment of 6 patients with esophageal cancer who developed anastomotic leakage with fistula after reconstruction via the subcutaneous route. A gastric tube and colon had been used for reconstruction in 2 and 4 patients, respectively. A trimming and repair of the leakage site was initially performed and the anastomotic site was then covered with a muscle flap. Results: Recurrent anastomotic leakage did not develop in 5 patients. Among these patients, oral intake was initiated from 11-15 days after the repair operation in 4 patients. A patient having recurrent anastomotic leakage after a repair operation recovered well with conservative therapy. Conclusion: The coverage with a PMM flap over the repair site is a simple method for preventing the development of recurrent leakage after a repair operation. Even when recurrent anastomotic leakage has occurred after this operation, healing is normally expected by means of conservative treatment. We, therefore, recommend this method for the repair of intractable anastomotic leakage after reconstruction via the subcutaneous route for esophageal cancer.

Original languageEnglish
Pages (from-to)212-218
Number of pages7
JournalSurgery
Volume147
Issue number2
DOIs
Publication statusPublished - Feb 1 2010

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Pectoralis Muscles
Anastomotic Leak
Esophageal Neoplasms
Cutaneous Fistula
Esophagectomy
Fistula
Stomach
Colon
Muscles

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Morita, M., Ikeda, K., Sugiyama, M., Saeki, H., Egashira, A., Yoshinaga, K., ... Maehara, Y. (2010). Repair using the pectoralis major muscle flap for anastomotic leakage after esophageal reconstruction via the subcutaneous route. Surgery, 147(2), 212-218. https://doi.org/10.1016/j.surg.2009.08.013

Repair using the pectoralis major muscle flap for anastomotic leakage after esophageal reconstruction via the subcutaneous route. / Morita, Masaru; Ikeda, Keisuke; Sugiyama, Masahiko; Saeki, Hiroshi; Egashira, Akinori; Yoshinaga, Keiji; Oki, Eiji; Sadanaga, Noriaki; Kakeji, Yoshihiro; Fukushima, Junichi; Maehara, Yoshihiko.

In: Surgery, Vol. 147, No. 2, 01.02.2010, p. 212-218.

Research output: Contribution to journalArticle

Morita, M, Ikeda, K, Sugiyama, M, Saeki, H, Egashira, A, Yoshinaga, K, Oki, E, Sadanaga, N, Kakeji, Y, Fukushima, J & Maehara, Y 2010, 'Repair using the pectoralis major muscle flap for anastomotic leakage after esophageal reconstruction via the subcutaneous route', Surgery, vol. 147, no. 2, pp. 212-218. https://doi.org/10.1016/j.surg.2009.08.013
Morita, Masaru ; Ikeda, Keisuke ; Sugiyama, Masahiko ; Saeki, Hiroshi ; Egashira, Akinori ; Yoshinaga, Keiji ; Oki, Eiji ; Sadanaga, Noriaki ; Kakeji, Yoshihiro ; Fukushima, Junichi ; Maehara, Yoshihiko. / Repair using the pectoralis major muscle flap for anastomotic leakage after esophageal reconstruction via the subcutaneous route. In: Surgery. 2010 ; Vol. 147, No. 2. pp. 212-218.
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AU - Egashira, Akinori

AU - Yoshinaga, Keiji

AU - Oki, Eiji

AU - Sadanaga, Noriaki

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AU - Fukushima, Junichi

AU - Maehara, Yoshihiko

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N2 - Background: Anastomotic leakage with an intractable cutaneous fistula frequently develops after an esophagectomy and reconstruction via the subcutaneous route. Methods: A pectoralis major muscle (PMM) flap was used for the treatment of 6 patients with esophageal cancer who developed anastomotic leakage with fistula after reconstruction via the subcutaneous route. A gastric tube and colon had been used for reconstruction in 2 and 4 patients, respectively. A trimming and repair of the leakage site was initially performed and the anastomotic site was then covered with a muscle flap. Results: Recurrent anastomotic leakage did not develop in 5 patients. Among these patients, oral intake was initiated from 11-15 days after the repair operation in 4 patients. A patient having recurrent anastomotic leakage after a repair operation recovered well with conservative therapy. Conclusion: The coverage with a PMM flap over the repair site is a simple method for preventing the development of recurrent leakage after a repair operation. Even when recurrent anastomotic leakage has occurred after this operation, healing is normally expected by means of conservative treatment. We, therefore, recommend this method for the repair of intractable anastomotic leakage after reconstruction via the subcutaneous route for esophageal cancer.

AB - Background: Anastomotic leakage with an intractable cutaneous fistula frequently develops after an esophagectomy and reconstruction via the subcutaneous route. Methods: A pectoralis major muscle (PMM) flap was used for the treatment of 6 patients with esophageal cancer who developed anastomotic leakage with fistula after reconstruction via the subcutaneous route. A gastric tube and colon had been used for reconstruction in 2 and 4 patients, respectively. A trimming and repair of the leakage site was initially performed and the anastomotic site was then covered with a muscle flap. Results: Recurrent anastomotic leakage did not develop in 5 patients. Among these patients, oral intake was initiated from 11-15 days after the repair operation in 4 patients. A patient having recurrent anastomotic leakage after a repair operation recovered well with conservative therapy. Conclusion: The coverage with a PMM flap over the repair site is a simple method for preventing the development of recurrent leakage after a repair operation. Even when recurrent anastomotic leakage has occurred after this operation, healing is normally expected by means of conservative treatment. We, therefore, recommend this method for the repair of intractable anastomotic leakage after reconstruction via the subcutaneous route for esophageal cancer.

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