TY - JOUR
AR - SCR-2021-3-101
TI - Laparoscopic Approach for Esophagojejunal Anastomotic Leak in Patients Requiring Re-Look Intervention: How We Do It
AU - Hai T , Bui
AU - Steven , T F Chan
JO - Surgical Case Reports
PY - 2021
DA - Tue 09, Mar 2021
SN - 2613-5965
DO - http://dx.doi.org/10.31487/j.SCR.2021.03.01
UR - https://www.sciencerepository.org/laparoscopic-approach-for-esophagojejunal-anastomotic-leak-in-patients_SCR-2021-3-101 
KW -  Laparoscopic surgery, total gastrectomy, esophagojejunal leak, isoperistaltic tube suction
AB - Background: Esophagojejunal anastomotic leak (EJAL) is a serious and often a life-threatening complication following total gastrectomy. There is no standard management strategy, and the optimal approach remains controversial. Whilst non-operative approach (with or without percutaneous drainage), endoscopic approach (stents, clips, and vacuum devices) is the preferred initial management, and there remains a subset of EJAL patients that require operative intervention because of the uncontrolled leak with sepsis and potential high mortality.
Methods: We present early clinical results of a minimally invasive novel surgical technique (continuous suction isoperistaltic jejuno-esophagostomy tube, SIJET) to divert saliva and enteric secretions away from the anastomotic area thus creating a hypothesised concept of “no leak” scenario. The details of this technique are described and illustrated.
Results: This is the first clinical report of a laparoscopic technique for insertion of SIJET in two patients with esophagojejunal anastomotic leaks managed successfully. Both patients had failed to progress on non-operative management because of the uncontrolled leak with sepsis.
Conclusion: The absolute prerequisite for complete healing of an anastomotic leak is adequate drainage of undrained fluid collections and diversion of luminal fluid away from the anastomotic defect. Laparoscopic SIJET provides a minimally invasive option for the management of esophagojejunal leak following total gastrectomy in patients with uncontrolled leak with sepsis.