Anastomotic Leakage after Upper Gastrointestinal Surgery: Surgical Treatment

Abstract

Background: Anastomotic leakage after upper gastrointestinal surgery is associated with major morbidity and mortality. In recent years, there was a major paradigm shift in the management of leakage after upper gastrointestinal surgery from surgical towards conservative and endoscopic treatment approaches as first-line treatment options. Methods: We conducted a PubMed literature search using combinations of the keywords 'leakage', 'complication', 'esophagectomy', 'gastrectomy', and 'pancreatectomy' to identify relevant publications. Results: Surgical re-intervention after esophagectomy, gastrectomy, or pancreatectomy is still indicated in selected patients, depending on the severity of symptoms, the condition of the patient, and failure of initiated treatment. Furthermore, surgical revision after esophagectomy and gastrectomy is indicated for early leakage and depends on the extent of anastomotic disruption and the condition of tissue. Conclusion: Surgical re-intervention still plays a crucial role in the management of leakage after upper gastrointestinal surgery, especially in critically ill patients and after failure of conservative or endoscopic treatment.