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

doi:10.1016/j.surg.2009.08.013

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Volume 147, Issue 2 , Pages 212-218, February 2010

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

Masaru Morita, MD, PhD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Reprint requests: Masaru Morita, MD, PhD, Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Keisuke Ikeda, MD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Masahiko Sugiyama, MD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Hiroshi Saeki, MD, PhD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Akinori Egashira, MD, PhD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Keiji Yoshinaga, MD, PhD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Eiji Oki, MD, PhD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Noriaki Sadanaga, MD, PhD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Yoshihiro Kakeji, MD, PhD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Junichi Fukushima, MD, PhD
- Department of Oto-Rhino-Laryngology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
Yoshihiko Maehara, MD, PhD
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

Accepted 28 August 2009. published online 02 November 2009.

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.