Bridging the gap: intraoperative esophageal stent used as a scaffold for the treatment of complete postsurgical gastroesophageal anastomosis dehiscence.

BACKGROUND AND AIMS: Esophagogastric (EG) anastomotic leaks are serious adverse events after esophagectomy. Endoscopic stent placement has become an effective, minimally invasive option that promotes healing. While esophageal stents maintain luminal continuity, technical success rates are as high as 90.9%. A 62-year-old man with esophageal adenocarcinoma presented 12 days after McKeown esophagectomy with dyspnea and empyema. Imaging and chest tube output suggested an anastomotic leak. The aim of this study was to display the utility of esophageal stent placement even in cases of complete EG dehiscence.

METHODS

Intraoperative exploration revealed complete EG dehiscence. Using robotic surgical guidance, we advanced a gastroscope through the mediastinum into the stomach, and a guidewire was passed to facilitate placement of a 20- × 100-mm fully covered self-expandable metal stent. Given the emergent intraoperative nature of the case and the use of a travel cart, endoscopic images are limited or mostly unavailable.

RESULTS

The stent provided a scaffold for reapproximation and repair with interrupted sutures and biological mesh. The patient recovered uneventfully, resumed tube feeds, and advanced to oral intake within 2 months. The stent was removed 4 months after placement without stricture or need for dilation.

CONCLUSIONS

Complete EG dehiscence typically necessitates high-risk surgical repair. In this case, endoscopic stent placement enabled luminal restoration and guided repair, demonstrating a novel multidisciplinary approach to a complex adverse event. Intraoperative endoscopic stent placement can successfully manage complete anastomotic dehiscence, emphasizing the value of coordinated surgical/endoscopic strategies to preserve function.