Intraoperative Methods of Verifying the Integrity of Esophagogastric Anastomosis and Preventing Encephalopathy after Lewis Esophagectomy

Introduction. The implementation of ERAS protocol principles (Esophagectomy Complications Consensus Group) in thoracic surgery requires the provision of early enteral nutrition, including after Lewis esophagectomy. However, high incidence of esophagogastric anastomosis failure and postoperative encephalopathy hinders the safe use of sipping feeding, requiring improved methods for preventing these complications. Aim. To evaluate the effectiveness of implemented methods for preventing esophagogastric anastomosis failure and encephalopathy after Lewis esophagectomy. Materials and methods. A retrospective-prospective analysis of treatment results is conducted in 121 patients after Lewis esophagectomy. The main group (n = 35) underwent methods for preventing esophagogastric anastomosis failure and postoperative encephalopathy, protected by Russian patents No. 2791399 C1 and No. 2810178 C1. The control group (n = 86) consisted of patients operated using the standard technique. Results. The use of the proposed methods in the main group ensured a stable reduction in the incidence of anastomotic leakage (0 vs 4.7%, p < 0.05), including a statistically significant reduction in the overall incidence of postoperative complications (8.6 vs 17.4%, p < 0.05), hospital mortality (2.9 vs 12.8%, p < 0.05) and duration of hospitalization (16±3 vs 21±4 days, p < 0.05). The main group observed no signs of postoperative encephalopathy, impaired consciousness, cognitive functions, or laboratory test values associated with hyperammonemia. Discussion. The obtained data confirm the proposed prevention methods aiming at the key pathogenetic mechanisms for the development of complications including anastomotic failure and encephalopathy associated with portal hypertension. Elimination of biliary hypertension and intraoperative monitoring of anastomotic leakage ensure the safe implementation of sipping nutrition and reduce rehabilitation time. Conclusion. The use of the proposed methods for preventing anastomotic leakage and postoperative encephalopathy after Lewis esophagectomy ensures the integrity of sutures, prevention of metabolic and cognitive impairment in the early postoperative period, and safe implementation of sipping nutrition. The obtained results confirm the pathogenetic validity of the approach and substantiate the prospects for its further clinical application.

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