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Methylene Blue (Mb) Test Versus Contrast Study (CS) in the Detection of Anastomotic Leak Following Oesogephactomy: a Prospective Study of 58 Patients
Adriana Rotundo*, Geoffrey Roberts, Francesco Pata, Geoff Pratt, Michael Harvey, Cheuk Bong Tang, Sritharan S. Kadirkamanathan
Upper GI Surgery, MEHT, Chelmsford, United Kingdom
Background: Anastomotic leak is a serious complication following oesophagectomy. It is associated with considerable morbidity and mortality. The aim of our study was to compare the accuracy of MB and CS (Gastrografin) in detecting anastomotic leaks after Ivor-Lewis oesophagectomy.
Methods: The study included 58 patients who underwent laparoscopic assisted Ivor-Lewis oesophagectomy from September 2009 to November 2011. All patients had intra-thoracic oesophago-gastric anastomosis, end to side using an endoscopic circular stapler (CDH © Ethicon Endo-Surgery, Inc.2010). The integrity of the anastomosis was checked on day 5 using both MB and CS. 100ml of Gastrografin was used in the CS which was performed by an experienced oesophageal radiologist. 10ml of MB diluted in 200ml of water was given orally to test the anastomosis. The CS was performed before the MB test and was reviewed by the radiologist who was blinded to the results of MB. MB test was considered positive when the dye was seen in the chest drain in less than 30 minutes. The leak was considered clinically significant if there was evidence of sepsis. Chi square test was used to assess the difference between the two investigations
Results: There were 37 males and 21 females with median age of 65 (range 43-78). Anastomotic leaks was diagnosed in 6 patients (10.3%). In 4 cases the leak was considered clinically significant (7%). MB detected all 4 significant leaks. CS detected 5 leaks, 3 clinical and 2 non-clinical, but was reported as a normal study in 1 of the clinically significant leak. All patients recovered with conservative management. There was no significant difference between MB and CS in diagnosing anastomotic leaks (p=ns)
Conclusion: Our study shows no difference between CS and MB in detecting anastomtic leaks. MB might be a more convenient investigation and could be used in a ward setting without the need for radiology. It could well form part of the strategy of enhanced recovery after surgery (ERAS) programme following oesophageal surgery.
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