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Page 4 of 10 Latorre-Rodríguez et al. Mini-invasive Surg 2023;7:6 https://dx.doi.org/10.20517/2574-1225.2022.104

Figure 1. The basic principles of managing esophageal anastomotic leaks. (Used with permission from Norton Thoracic Institute, St.
Joseph’s Hospital, and Medical Center, Phoenix, Arizona).

The correct surgical approach must be reviewed and adjusted on a case-by-case basis. Some key factors that
impact the choice of surgical technique are the presence or absence of empyema, conduit ischemia/necrosis,
sepsis, and compromise of the gastric fundus [4,20,21] .

The choice of open versus thoracoscopic surgical intervention depends on available surgical expertise; the
presence of empyema, sepsis, or tissue necrosis generally requires an open procedure . The contents of the
[4]
leak must be drained, and the remaining tissue should be preserved [4,13] . Thoracoscopy, thoracotomy,
cervicotomy, implantation of pedicle flaps, and gastric tube resection are some of the surgical management
approaches used for esophageal ALs .
[4]

NOVEL TECHNIQUES
Major re-operative surgical interventions for ALs increase morbidity and the chance of GI tract diversion.
Increasingly, less invasive management techniques are used to manage ALs. Advances in endoscopic
techniques have made it possible to develop and adopt novel devices and technologies that stand out for
their effectiveness and simplicity of use in clinical practice while adhering to the essential principles of AL
management delineated above. As a result, the mortality rates associated with major ALs have decreased.
Two endoscopic techniques that have become more common are self-expandable metal stents (SEMS) and
endoluminal vacuum therapy (E-Vac). These endoscopic techniques, in addition to the availability of
radiology-guided drain placement, have brought about a dramatic and welcome change in the management
of ALs and the associated morbidity and mortality.