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January 1988

'Noninvasive' Treatment of Esophagogastric Anastomotic Leakage

Arch Surg. 1988;123(1):124. doi:10.1001/archsurg.1988.01400250134032

To the Editor.—We would like to comment on the interesting brief communication by Ofek and Hoffmann.1

In 1905, Yates2 concluded that drainage was impossible because of encapsulation of the drain. This remains a problem.

Leakage following esophagogastric or esophagojejunal anastomosis is a serious complication with a high mortality rate. We agree with Drs Ofek and Hoffmann that surgical treatment of anastomotic leakage is often ineffective in preventing prolonged morbidity and mortality. We should stress, however, that modern localization of collections by means of computed tomographic scan and/or ultrasonography following esophageal leakage and drainage by percutaneous placement of catheter is effective in most cases.

We have successfully treated four cases of subdiaphragmatic or lower mediastinal collections from esophageal leakage by this method (Figure).

We admit that drainage of the leak via a nasoesophageal tube placed through the defect may occasionally have a place; however, this "unorthodox" method of

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