49chest drain, which may be turbid in color, lead to diagnosis.
The location and magnitude of the leak can be visualized by a
water-soluble contrast study. A carefully performed flexible
endoscopic examination is also helpful. For small contained
leaks, CT-guided drainage of pockets of collection may suffice.
In septic patients with a sizable leak, exploration is warranted.
Direct repair is seldom possible or effective, drainage is the key.
Injection of fibrin glue or placement of intraluminal stents is
increasingly used to treat leaks, sealing of the leak allows early
control of sepsis and resumption of oral alimentation. The
stent can be removed afterward, depending on the severity of
the leak in the first place. Usually, 4–6 weeks will suffice for
adequate healing.- Delayed gastric emptying. A routine pyloric drainage procedure
is helpful but does not eliminate this complication because of
other contributory factors. Malrotation of the gastric conduit is
rare but is serious and should prompt immediate re-explora-
tion. A larger gastric tube has more tendency of gastric reten-
tion, especially when an Ivor-Lewis operation is performed; the
redundant part of the stomach tends to form a pocket above
the diagram, which turns anteriorly and medially before coming
through the diaphragmatic hiatus into the abdomen. The stom-
ach placed in the retrosternal route (when a cervical anastomo-
sis is elected) also has less change of delayed emptying.
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