The pleural cavity and mediastinum should be debrided, thoroughly irrigated and adequately drained with large bore drains and chest tubes. For anastomosis that are performed at the cervical esophagus in the neck a more conservative approach is more frequently taken. The drainage can be controlled by opening the cervical incision. The risk of mediastinitis is minimal as is the mortality risk. With adequate drainage the leak usually spontaneously closes within 1-2 weeks.
Nutritional support is maintained by an enteral feeding tube.
In approximately half of patients who have an anastomotic leak will experience stricture. Most strictures are relieved by esophageal dilation. All rights reserved.