T-tube management of a major leakage of the cervical esophagogastrostomy after subtotal esophagectomy: report of three cases.

A major leakage of the cervical esophagogastrostomy caused by necrosis of the esophageal substitute was successfully managed in three patients by inserting a T-tube. After partial necrosis of the gastric tube had been confirmed, a T-tube was inserted into the esophagus and the gastric tube through the reopened cervical wound. In one patient, a plastic esophageal prosthesis and subsequently, a covered self-expandable metallic stent were intubated over the fistula after T-tube removal to prevent salivary leakage and anastomotic stenosis. In the other two patients, the sump tube, which had been inserted through the gastrostomy for decompression during surgery, was replaced with a large chest drainage tube, the tip of which was positioned in the esophagus, after T-tube removal. The fistula was closed without severe stenosis, and oral feeding was resumed on postoperative days 71 and 64, respectively.