SlideShare una empresa de Scribd logo
1 de 31
Anastomotic Leakage after Oesophagectomy for Cancer: A Mortality-Free Experience Abeezar I Sarela, Damian J Tolan, Keith Harris,  Simon P Dexter, Henry M Sue-Ling Departments of Upper GI Surgery & Radiology The General Infirmary at Leeds J Am Coll Surg 2008;206:516–523
Intra-Thoracic Oesophago-Gastric Anastomosis Routine POD #7 Gastrograffin Swallows – No Leakage 1 2 3
Intra-Thoracic Leakage Case # 1 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Early Post-operative Leakage:  Limited Necrosis of Gastric Tube Repair of gastric tube around a 16Fr T-tube
Intra-Thoracic Leakage Case # 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],Early Post-operative Leakage: Extensive Necrosis of Gastric Tube
Intra-Thoracic Leakage Case #3 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed Post-operative Leakage: Contained Sepsis, No Necrosis  Leakage from anastomosis Mediastinal sinus, no cavity Anastomotic dehiscence No necrosis Non-Interventional Treatment
Intra-Thoracic Leakage Case#4 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed Post-operative Intra-Thoracic Leakage: Apical Sinus + Pleural Cavity Leakage from apex of gastric tube Cavity with air-fluid level Percutaneous drainage by interventional radiology
Intra-Thoracic Leakage Case # 5 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed Post-operative Leakage: Generalised Pleural Contamination  POD#8 POD#9 6.30AM POD#9 9.00PM ,[object Object],[object Object]
Intra-Thoracic Leakage Case # 6 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Suspected leakage at O-G anastomosis
Intra-Thoracic Leakage Case # 7 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Clinically suspected delayed post-operative leakage; Normal radiology Normal repeated contrast swallows Normal repeated cross-sectional imaging Normal Upper GI Endoscopy
Cervical Oesophago-Gastric Anastomosis Neck Upper chest Lower chest Abdomen Routine POD #7 Gastrograffin Swallows – No Leakage
Cervical Leakage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delayed Post-operative Cervical Anastomotic Leakage POD#12 Neck Sinus  POD #17 Retro-sternal sinus POD#25 Pre-vertebral cavity
Implications  of Anastomotic Leakage ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer The General Infirmary at Leeds ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Identification of Leakage ,[object Object],[object Object],[object Object],[object Object]
Site of Leakage ,[object Object],[object Object],[object Object],[object Object],[object Object]
Intra-Thoracic Anastomosis 103 patients
Intra-Thoracic Anastomotic Leakage ,[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer Memorial Sloan Kettering Cancer Center   ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer Queen Mary Hospital, Hong Kong ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer Royal Victoria Hospital, Newcastle ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Oesophageal Resection for Cancer  University of Michigan ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Personal Lessons ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 

Más contenido relacionado

La actualidad más candente

Minimally invasive oesophagectomy
Minimally invasive oesophagectomyMinimally invasive oesophagectomy
Minimally invasive oesophagectomy
foregutsurgeon
 
Urgent Early Laparoscopic Reassessment
Urgent Early Laparoscopic ReassessmentUrgent Early Laparoscopic Reassessment
Urgent Early Laparoscopic Reassessment
George S. Ferzli
 
Diagnostic Laparoscopy for ITU patients
Diagnostic Laparoscopy for ITU patientsDiagnostic Laparoscopy for ITU patients
Diagnostic Laparoscopy for ITU patients
Arshad Hayat
 
Innovative Surgical Techiniques in Hepatobiliary and Pancreatic Surgery
Innovative Surgical Techiniques in Hepatobiliary and Pancreatic SurgeryInnovative Surgical Techiniques in Hepatobiliary and Pancreatic Surgery
Innovative Surgical Techiniques in Hepatobiliary and Pancreatic Surgery
ISWANTO SUCANDY, M.D, F.A.C.S
 

La actualidad más candente (20)

Minimally invasive oesophagectomy
Minimally invasive oesophagectomyMinimally invasive oesophagectomy
Minimally invasive oesophagectomy
 
Management of Gall Bladder Polyps
Management of Gall Bladder PolypsManagement of Gall Bladder Polyps
Management of Gall Bladder Polyps
 
Urgent Early Laparoscopic Reassessment
Urgent Early Laparoscopic ReassessmentUrgent Early Laparoscopic Reassessment
Urgent Early Laparoscopic Reassessment
 
Esd
EsdEsd
Esd
 
Post operative crohn’s disease
Post operative crohn’s diseasePost operative crohn’s disease
Post operative crohn’s disease
 
Role of laparoscopic surgery in colorectal cancer
Role of laparoscopic surgery in colorectal cancerRole of laparoscopic surgery in colorectal cancer
Role of laparoscopic surgery in colorectal cancer
 
D2 distal gastrectomy final
D2 distal gastrectomy finalD2 distal gastrectomy final
D2 distal gastrectomy final
 
Therapeutic Eus 2008
Therapeutic Eus 2008Therapeutic Eus 2008
Therapeutic Eus 2008
 
Diagnostic Laparoscopy for ITU patients
Diagnostic Laparoscopy for ITU patientsDiagnostic Laparoscopy for ITU patients
Diagnostic Laparoscopy for ITU patients
 
Esophagus cancer
Esophagus cancerEsophagus cancer
Esophagus cancer
 
Innovative Surgical Techiniques in Hepatobiliary and Pancreatic Surgery
Innovative Surgical Techiniques in Hepatobiliary and Pancreatic SurgeryInnovative Surgical Techiniques in Hepatobiliary and Pancreatic Surgery
Innovative Surgical Techiniques in Hepatobiliary and Pancreatic Surgery
 
Management ca esophagus sneha
Management ca esophagus snehaManagement ca esophagus sneha
Management ca esophagus sneha
 
Crohn's Disease by Dr Harsh Shah, Kaizen Hospital, Ahmedabad, India
Crohn's Disease by Dr Harsh Shah, Kaizen Hospital, Ahmedabad, IndiaCrohn's Disease by Dr Harsh Shah, Kaizen Hospital, Ahmedabad, India
Crohn's Disease by Dr Harsh Shah, Kaizen Hospital, Ahmedabad, India
 
Pancreas anatomy for experts by Dr Harsh Shah(www.gastroclinix.com)
Pancreas anatomy for experts by Dr Harsh Shah(www.gastroclinix.com)Pancreas anatomy for experts by Dr Harsh Shah(www.gastroclinix.com)
Pancreas anatomy for experts by Dr Harsh Shah(www.gastroclinix.com)
 
D2 distal gastrectomy
D2 distal gastrectomyD2 distal gastrectomy
D2 distal gastrectomy
 
EUS Guided Interventions for Pancreatobiliary Tumours
EUS Guided Interventions for Pancreatobiliary TumoursEUS Guided Interventions for Pancreatobiliary Tumours
EUS Guided Interventions for Pancreatobiliary Tumours
 
Subepithelial lesions
Subepithelial lesionsSubepithelial lesions
Subepithelial lesions
 
Gastric cancer debate adjuvant chemoradiotherapy
Gastric cancer debate  adjuvant chemoradiotherapyGastric cancer debate  adjuvant chemoradiotherapy
Gastric cancer debate adjuvant chemoradiotherapy
 
SAGES Guidelines | Summary
SAGES Guidelines | SummarySAGES Guidelines | Summary
SAGES Guidelines | Summary
 
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAP
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAPCOMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAP
COMPOSITE GRAFT: ANTROPYLORUS TRANSPOSITION AND GLUTEUS MAXIMUS WRAP
 

Destacado (9)

Carcinoma de la union gastroesogafica
Carcinoma de la union gastroesogaficaCarcinoma de la union gastroesogafica
Carcinoma de la union gastroesogafica
 
Laparoscopic gastrectomies for cancer
Laparoscopic gastrectomies for cancerLaparoscopic gastrectomies for cancer
Laparoscopic gastrectomies for cancer
 
The surgical management of gastroesophageal cancer
The surgical management of gastroesophageal cancerThe surgical management of gastroesophageal cancer
The surgical management of gastroesophageal cancer
 
Pancreatic Carcinoma
Pancreatic CarcinomaPancreatic Carcinoma
Pancreatic Carcinoma
 
Carcinoma esophagus
Carcinoma esophagusCarcinoma esophagus
Carcinoma esophagus
 
Cancer de esofago
Cancer de esofagoCancer de esofago
Cancer de esofago
 
Carcinoma oesophagus
Carcinoma  oesophagusCarcinoma  oesophagus
Carcinoma oesophagus
 
Técnica Quirúrgica, Instrumental Quirúrgico
Técnica Quirúrgica, Instrumental QuirúrgicoTécnica Quirúrgica, Instrumental Quirúrgico
Técnica Quirúrgica, Instrumental Quirúrgico
 
Esophageal adenocarcinoma p t1 sages
Esophageal adenocarcinoma p t1   sagesEsophageal adenocarcinoma p t1   sages
Esophageal adenocarcinoma p t1 sages
 

Similar a Leakage after oesophagectomy

Mis carcinoma Esophagus
Mis carcinoma Esophagus Mis carcinoma Esophagus
Mis carcinoma Esophagus
Dr Harsh Shah
 
Respiratory emergencies
Respiratory emergenciesRespiratory emergencies
Respiratory emergencies
Fatma Elbadry
 
Management of abdominal trauma.ppt1
Management of abdominal trauma.ppt1Management of abdominal trauma.ppt1
Management of abdominal trauma.ppt1
drchano
 
Case Of Acute Intestinal Obstruction (1).pptx
Case Of Acute  Intestinal Obstruction (1).pptxCase Of Acute  Intestinal Obstruction (1).pptx
Case Of Acute Intestinal Obstruction (1).pptx
Haris Bela
 

Similar a Leakage after oesophagectomy (20)

Empyma in children
Empyma in childrenEmpyma in children
Empyma in children
 
BRONCHOPLEURAL fistula pptx.............
BRONCHOPLEURAL fistula pptx.............BRONCHOPLEURAL fistula pptx.............
BRONCHOPLEURAL fistula pptx.............
 
MCC 2011 - Slide 19
MCC 2011 - Slide 19MCC 2011 - Slide 19
MCC 2011 - Slide 19
 
Peritonectomy2 Asgo 2007
Peritonectomy2 Asgo 2007Peritonectomy2 Asgo 2007
Peritonectomy2 Asgo 2007
 
Mis carcinoma Esophagus
Mis carcinoma Esophagus Mis carcinoma Esophagus
Mis carcinoma Esophagus
 
Parapneumonic effusion
Parapneumonic effusionParapneumonic effusion
Parapneumonic effusion
 
Abdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptxAbdominal Imaging Case Studies #27.pptx
Abdominal Imaging Case Studies #27.pptx
 
Respiratory emergencies
Respiratory emergenciesRespiratory emergencies
Respiratory emergencies
 
Bronchopleural fistula anesthetic concerns
Bronchopleural fistula  anesthetic concernsBronchopleural fistula  anesthetic concerns
Bronchopleural fistula anesthetic concerns
 
Management of abdominal trauma.ppt1
Management of abdominal trauma.ppt1Management of abdominal trauma.ppt1
Management of abdominal trauma.ppt1
 
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July CasesDrs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
Drs. Potter and Richardson's CMC Pediatric X-Ray Mastery July Cases
 
Floating anus and testicles secondary to Fournier's gangrene.pptx
Floating anus and testicles secondary to Fournier's gangrene.pptxFloating anus and testicles secondary to Fournier's gangrene.pptx
Floating anus and testicles secondary to Fournier's gangrene.pptx
 
Crs+hipec— jeddah,
Crs+hipec— jeddah,Crs+hipec— jeddah,
Crs+hipec— jeddah,
 
Crs+hipec— jeddah,
Crs+hipec— jeddah,Crs+hipec— jeddah,
Crs+hipec— jeddah,
 
Dr. Escobar’s CMC X-Ray Mastery Project: December Cases
Dr. Escobar’s CMC X-Ray Mastery Project: December CasesDr. Escobar’s CMC X-Ray Mastery Project: December Cases
Dr. Escobar’s CMC X-Ray Mastery Project: December Cases
 
GI and Liver Malignancies
GI and Liver MalignanciesGI and Liver Malignancies
GI and Liver Malignancies
 
Catheter
CatheterCatheter
Catheter
 
Case Of Acute Intestinal Obstruction (1).pptx
Case Of Acute  Intestinal Obstruction (1).pptxCase Of Acute  Intestinal Obstruction (1).pptx
Case Of Acute Intestinal Obstruction (1).pptx
 
EMGuideWire's Radiology Reading Room: Pneumomediastinum
EMGuideWire's Radiology Reading Room: PneumomediastinumEMGuideWire's Radiology Reading Room: Pneumomediastinum
EMGuideWire's Radiology Reading Room: Pneumomediastinum
 
18
1818
18
 

Más de foregutsurgeon

Rationale for Bariatric surgery: Medical & Financial Arguments
Rationale for Bariatric surgery:  Medical & Financial ArgumentsRationale for Bariatric surgery:  Medical & Financial Arguments
Rationale for Bariatric surgery: Medical & Financial Arguments
foregutsurgeon
 
Gastric Electrical Stimulation for Gastroparesis
Gastric Electrical Stimulation for GastroparesisGastric Electrical Stimulation for Gastroparesis
Gastric Electrical Stimulation for Gastroparesis
foregutsurgeon
 
Surgery is Better than Medical Management for Non-Alcoholic Fatty Liver Disease
Surgery is Better than Medical Management for Non-Alcoholic Fatty Liver DiseaseSurgery is Better than Medical Management for Non-Alcoholic Fatty Liver Disease
Surgery is Better than Medical Management for Non-Alcoholic Fatty Liver Disease
foregutsurgeon
 
Weight loss surgery safe & effective
Weight loss surgery   safe & effectiveWeight loss surgery   safe & effective
Weight loss surgery safe & effective
foregutsurgeon
 
Weight loss surgery overview
Weight loss surgery   overviewWeight loss surgery   overview
Weight loss surgery overview
foregutsurgeon
 
Stomach pacemaker for weight loss
Stomach pacemaker for weight lossStomach pacemaker for weight loss
Stomach pacemaker for weight loss
foregutsurgeon
 
The future of bariatric surgery
The future of bariatric surgeryThe future of bariatric surgery
The future of bariatric surgery
foregutsurgeon
 
Long term outcomes of the laparoscopic sleeve gastrectomy
Long term outcomes of the laparoscopic sleeve gastrectomyLong term outcomes of the laparoscopic sleeve gastrectomy
Long term outcomes of the laparoscopic sleeve gastrectomy
foregutsurgeon
 
Incisionless procedures and stomach pacemaker for obesity
Incisionless procedures and stomach pacemaker for obesityIncisionless procedures and stomach pacemaker for obesity
Incisionless procedures and stomach pacemaker for obesity
foregutsurgeon
 
Emergencies after bariatric surgery
Emergencies after bariatric surgeryEmergencies after bariatric surgery
Emergencies after bariatric surgery
foregutsurgeon
 
History of bariatric surgery
History of bariatric surgeryHistory of bariatric surgery
History of bariatric surgery
foregutsurgeon
 
Non cardiac chest pain
Non cardiac chest painNon cardiac chest pain
Non cardiac chest pain
foregutsurgeon
 
Laparoscopic groin hernia repair anatomy & technique
Laparoscopic groin hernia repair   anatomy & techniqueLaparoscopic groin hernia repair   anatomy & technique
Laparoscopic groin hernia repair anatomy & technique
foregutsurgeon
 
Laparoscopy for gastric cancer
Laparoscopy for gastric cancerLaparoscopy for gastric cancer
Laparoscopy for gastric cancer
foregutsurgeon
 
Laparoscopic surgery for small bowel tumours
Laparoscopic surgery for small bowel tumoursLaparoscopic surgery for small bowel tumours
Laparoscopic surgery for small bowel tumours
foregutsurgeon
 

Más de foregutsurgeon (20)

Rationale for Bariatric surgery: Medical & Financial Arguments
Rationale for Bariatric surgery:  Medical & Financial ArgumentsRationale for Bariatric surgery:  Medical & Financial Arguments
Rationale for Bariatric surgery: Medical & Financial Arguments
 
Gastric Electrical Stimulation for Gastroparesis
Gastric Electrical Stimulation for GastroparesisGastric Electrical Stimulation for Gastroparesis
Gastric Electrical Stimulation for Gastroparesis
 
Surgery is Better than Medical Management for Non-Alcoholic Fatty Liver Disease
Surgery is Better than Medical Management for Non-Alcoholic Fatty Liver DiseaseSurgery is Better than Medical Management for Non-Alcoholic Fatty Liver Disease
Surgery is Better than Medical Management for Non-Alcoholic Fatty Liver Disease
 
Weight loss surgery safe & effective
Weight loss surgery   safe & effectiveWeight loss surgery   safe & effective
Weight loss surgery safe & effective
 
Weight loss surgery overview
Weight loss surgery   overviewWeight loss surgery   overview
Weight loss surgery overview
 
Stomach pacemaker for weight loss
Stomach pacemaker for weight lossStomach pacemaker for weight loss
Stomach pacemaker for weight loss
 
The future of bariatric surgery
The future of bariatric surgeryThe future of bariatric surgery
The future of bariatric surgery
 
Metabolic surgery
Metabolic surgeryMetabolic surgery
Metabolic surgery
 
Long term outcomes of the laparoscopic sleeve gastrectomy
Long term outcomes of the laparoscopic sleeve gastrectomyLong term outcomes of the laparoscopic sleeve gastrectomy
Long term outcomes of the laparoscopic sleeve gastrectomy
 
Incisionless procedures and stomach pacemaker for obesity
Incisionless procedures and stomach pacemaker for obesityIncisionless procedures and stomach pacemaker for obesity
Incisionless procedures and stomach pacemaker for obesity
 
Sop for rygb
Sop for rygbSop for rygb
Sop for rygb
 
Emergencies after bariatric surgery
Emergencies after bariatric surgeryEmergencies after bariatric surgery
Emergencies after bariatric surgery
 
History of bariatric surgery
History of bariatric surgeryHistory of bariatric surgery
History of bariatric surgery
 
Anti reflux surgery
Anti reflux surgeryAnti reflux surgery
Anti reflux surgery
 
Non cardiac chest pain
Non cardiac chest painNon cardiac chest pain
Non cardiac chest pain
 
Laparoscopic groin hernia repair anatomy & technique
Laparoscopic groin hernia repair   anatomy & techniqueLaparoscopic groin hernia repair   anatomy & technique
Laparoscopic groin hernia repair anatomy & technique
 
Groin hernia repair
Groin hernia repairGroin hernia repair
Groin hernia repair
 
Gastroparesis
GastroparesisGastroparesis
Gastroparesis
 
Laparoscopy for gastric cancer
Laparoscopy for gastric cancerLaparoscopy for gastric cancer
Laparoscopy for gastric cancer
 
Laparoscopic surgery for small bowel tumours
Laparoscopic surgery for small bowel tumoursLaparoscopic surgery for small bowel tumours
Laparoscopic surgery for small bowel tumours
 

Último

Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
adilkhan87451
 
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Sheetaleventcompany
 
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
Call Girls In Delhi Whatsup 9873940964 Enjoy Unlimited Pleasure
 

Último (20)

Call Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 8250077686 Top Class Call Girl Service Available
 
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
Premium Bangalore Call Girls Jigani Dail 6378878445 Escort Service For Hot Ma...
 
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Amritsar Just Call 8250077686 Top Class Call Girl Service Available
 
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
Low Rate Call Girls Bangalore {7304373326} ❤️VVIP NISHA Call Girls in Bangalo...
 
Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...
Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...
Models Call Girls In Hyderabad 9630942363 Hyderabad Call Girl & Hyderabad Esc...
 
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on WhatsappMost Beautiful Call Girl in Bangalore Contact on Whatsapp
Most Beautiful Call Girl in Bangalore Contact on Whatsapp
 
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
💕SONAM KUMAR💕Premium Call Girls Jaipur ↘️9257276172 ↙️One Night Stand With Lo...
 
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
Independent Call Girls Service Mohali Sector 116 | 6367187148 | Call Girl Ser...
 
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...Top Rated  Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
Top Rated Hyderabad Call Girls Erragadda ⟟ 9332606886 ⟟ Call Me For Genuine ...
 
Call Girls Mumbai Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Mumbai Just Call 8250077686 Top Class Call Girl Service AvailableCall Girls Mumbai Just Call 8250077686 Top Class Call Girl Service Available
Call Girls Mumbai Just Call 8250077686 Top Class Call Girl Service Available
 
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
Russian Call Girls Lucknow Just Call 👉👉7877925207 Top Class Call Girl Service...
 
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
Premium Call Girls In Jaipur {8445551418} ❤️VVIP SEEMA Call Girl in Jaipur Ra...
 
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...
Call Girls Service Jaipur {9521753030 } ❤️VVIP BHAWNA Call Girl in Jaipur Raj...
 
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Madurai Just Call 9630942363 Top Class Call Girl Service Available
 
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...Top Rated  Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
Top Rated Hyderabad Call Girls Chintal ⟟ 9332606886 ⟟ Call Me For Genuine Se...
 
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
Andheri East ) Call Girls in Mumbai Phone No 9004268417 Elite Escort Service ...
 
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service AvailableCall Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
Call Girls Ahmedabad Just Call 9630942363 Top Class Call Girl Service Available
 
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
Dehradun Call Girls Service {8854095900} ❤️VVIP ROCKY Call Girl in Dehradun U...
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
 
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
🌹Attapur⬅️ Vip Call Girls Hyderabad 📱9352852248 Book Well Trand Call Girls In...
 

Leakage after oesophagectomy