Komplikationsmanagement nach ösophagektomie

Abstract

Anastomotic leakages with subsequent mediastinitis remain the most severe complication after esophagectomy and the major cause of morbidity and mortality. The local intrathoracic inflammatory processes (mediastinitis) lead straight into systemic sequelae and widespread extrathoracic systemic reactions (sepsis) and tissue injury. Rapid diagnosis and an early goal-directed causal sepsis therapy is crucial. This includes radical focus sanitation as well as aggressive systemic antibiotics and sepsis therapy. Predominantly, early diagnosis should include direct endoscopic inspection of the anastomosis to evaluate the vitality of the anastomosed organs and the size of the leakage. According to location and clinical classification of the leak, the spectrum of therapeutic options ranges from simple drainage procedures, endoscopic interventions and stent implantation to re-operation or discontinuity resection. Fundamental requirements for successful management are both immediate and aggressive local interventions and well-established concepts in sepsis therapy. Copyright © 2008 S. Karger AG.