Abstract：
Acute volvulus of the gastric conduit is a rare complication after esophagectomy that warrants surgical intervention and is associated with increased morbidity and mortality. The aim of the study is to evaluate whether fixation of the gastric conduit would reduce the incidence of postoperative volvulus following esophagectomy.
This single-center retrospective analysis of patients who underwent esophagectomy was conducted to determine the incidence of acute postoperative volvulus following a change in practice. All patients who underwent an esophagectomy from September 2013 to November 2022 were included. We compared postoperative outcomes of gastric conduit volvulus, reoperations, morbidity, and mortality among those who had fixation versus non-fixation of the conduit to the right pleural edge.
Two hundred and forty-two consecutive patients underwent minimally invasive esophagectomy (81% male, 41% were < 67 years old). The first 121 (50%) patients did not undergo fixation of the gastric conduit, while the subsequent 121 (50%) patients did undergo fixation. Comparing both groups, there were no significant differences in major complications, anastomotic leak, and 30-day and 90-day all-cause mortality. Four (2%) patients developed gastric conduit volvulus in the non-fixation group, requiring reoperative intervention. Following implementation of fixation, no patient experienced gastric volvulus.
Acute volvulus of the gastric conduit is a rare complication after esophagectomy. Early diagnosis and surgical intervention are critical. In this study, although not statistically significant, fixation of the gastric conduit did reduce the number of patients who experienced postoperative volvulus. Additional future studies are needed to validate this technique and the prevention of postoperative acute gastric conduit volvulus among a diverse patient population.
This single-center retrospective analysis of patients who underwent esophagectomy was conducted to determine the incidence of acute postoperative volvulus following a change in practice. All patients who underwent an esophagectomy from September 2013 to November 2022 were included. We compared postoperative outcomes of gastric conduit volvulus, reoperations, morbidity, and mortality among those who had fixation versus non-fixation of the conduit to the right pleural edge.
Two hundred and forty-two consecutive patients underwent minimally invasive esophagectomy (81% male, 41% were < 67 years old). The first 121 (50%) patients did not undergo fixation of the gastric conduit, while the subsequent 121 (50%) patients did undergo fixation. Comparing both groups, there were no significant differences in major complications, anastomotic leak, and 30-day and 90-day all-cause mortality. Four (2%) patients developed gastric conduit volvulus in the non-fixation group, requiring reoperative intervention. Following implementation of fixation, no patient experienced gastric volvulus.
Acute volvulus of the gastric conduit is a rare complication after esophagectomy. Early diagnosis and surgical intervention are critical. In this study, although not statistically significant, fixation of the gastric conduit did reduce the number of patients who experienced postoperative volvulus. Additional future studies are needed to validate this technique and the prevention of postoperative acute gastric conduit volvulus among a diverse patient population.
摘要：
背景：急性胃导管扭转是食管切除术后的一种罕见并发症，需要手术干预，并与发病率和死亡率增加相关。该研究的目的是评估固定胃导管是否会减少食道切除术后术后肠扭转的发生率。
方法：对行食管切除术的患者进行单中心回顾性分析，以确定实践改变后急性术后肠扭转的发生率。纳入2013年9月至2022年11月接受食管切除术的所有患者。我们比较了胃导管扭转的术后结果，重新操作,发病率，导管固定和未固定到右胸膜边缘的患者的死亡率。
结果：两百四十二例连续患者接受了微创食管切除术（81%为男性，41％<67岁）。前121例（50%）患者未进行胃导管固定，而随后的121例（50％）患者确实进行了固定。比较两组，主要并发症没有显着差异，吻合口漏,30天和90天全因死亡率。非固定组有4例（2％）患者发生胃导管扭转，需要再次手术干预.实施固定后，没有患者出现胃扭转。
结论：急性胃导管扭转是食管切除术后罕见的并发症。早期诊断和手术干预至关重要。在这项研究中,虽然没有统计学意义，固定胃导管确实减少了术后发生肠扭转的患者数量.需要进一步的未来研究来验证该技术以及在不同患者人群中预防术后急性胃导管扭转。
方法：对行食管切除术的患者进行单中心回顾性分析，以确定实践改变后急性术后肠扭转的发生率。纳入2013年9月至2022年11月接受食管切除术的所有患者。我们比较了胃导管扭转的术后结果，重新操作,发病率，导管固定和未固定到右胸膜边缘的患者的死亡率。
结果：两百四十二例连续患者接受了微创食管切除术（81%为男性，41％<67岁）。前121例（50%）患者未进行胃导管固定，而随后的121例（50％）患者确实进行了固定。比较两组，主要并发症没有显着差异，吻合口漏,30天和90天全因死亡率。非固定组有4例（2％）患者发生胃导管扭转，需要再次手术干预.实施固定后，没有患者出现胃扭转。
结论：急性胃导管扭转是食管切除术后罕见的并发症。早期诊断和手术干预至关重要。在这项研究中,虽然没有统计学意义，固定胃导管确实减少了术后发生肠扭转的患者数量.需要进一步的未来研究来验证该技术以及在不同患者人群中预防术后急性胃导管扭转。
