What is the best way heal anastamosis esophogeal...

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Anastamotic leakage after gastrectomy
Gastrectomy is a procedure that involve total of partial removal of the stomch due to various causes mostly gastric tumors , through the procedure the esophagus is directly anastamosed to the gastric reminant or jejenum . After procedure the patient will have drains to monitor the abdominal cavity for any unusual content that might result from leak at the anastamotic site. Leak is mostly occure at the 7th post operative day and cause significant increase in mortality and hospital stay. The patient show signs of fever , abdominal pain , tachcardia , dyspnea and Leukocytosis in addition to change in drain content to a greenish fluid. If left untreated or delayed in diagnosis it will cause sepsis and death. Treatment options are challenging and categorized in to conservative , endoscopic or open surgical options. Candidates for conservative management are those patients who have symptoms without significant vital signs disturbances ie;stable BP and  heart rate, in addition to proved small size leak of less than 10% with low output drain less than 500 ml /day . Conservative treatment include initiation of Total parentral nutrition, IV antibiotics and aspiration of any sealed collection. Endoscopic self expandable stents can be used . If the patients showed signs of sepsis and shock he should underwent emergency surgery to repair leak and perform proper drainage of abdominal or thoracic contents , the surgery it self carries a significant rise in mortality and Morbidity. A consultation of upper gastroentrology surgeon is adviced.
Investigations
after proper physical exam , the patient vitals should be checked in addition to CBC to detect leukocytosis, CRP should be done to check for active inflammatory process, chest and abdominal CT scan is the preferred diagnostic modality preferably with oral contrast if possible .
risk factors for anastamotic leak

• Anemia Hgb less than 7
• Emergency surgery
• Low Albumin less than 2.8
• Acidosis 
• malignancy
• Technical failure 

Our. Advice
The patient should be managed in highly specialized center