Anastomotic diameter of circular stapled oesophagojejunal anastomoses and its implication for weight development. A clinical and experimental study.
OBJECTIVE
To investigate the increase in diameter of the oesophagojejunal anastomosis after total gastrectomy with a circular stapler, and to assess experimentally the influence of oesophageal diameter on weight.


METHODS
Open prospective clinical and experimental studies.


METHODS
University department of surgery, Sweden. SUBJECTS AND MATERIAL: 36 Consecutive patients who underwent total gastrectomy, and 13 domestic pigs.


METHODS
Clinical study: the end to side oesophagojejunal anastomoses were made with EEA staplers size 25 or 28, and the increase in diameter over a 12 month period was studied by by fibreoptic endoscopy. Experimental study: Each pig had 0.5 cm of the distal oesophagus resected; in 7 the oesophagus was anastomosed with one layer of continuous 3/0 polyglycolic acid, and in 6 an ILS21 stapler was used. Animals were weighed and killed at 4 1/2 months, and the width of the oesophagus at and below the anastomosis was measured.


METHODS
Clinical study: width of the oesophagus at 12 months. Experimental study: correlation between weight and oesophageal width at time of death.


RESULTS
Clinical study: The median increase in size after 12 months with the size 25 cartridge was 8.45 mm (range 6.5-22), and for the size 28 cartridge 12 mm (2.3-30.2). The larger cartridge gave a significantly larger anastomosis (p = 0.007), but the comparative increases were similar. Experimental study: There was a significant correlation between increase in weight and anastomotic width in the 10 pigs that completed the study (r = 0.86, p < 0.001).


CONCLUSIONS
A stapled oesophagojejunal anastomosis has the ability to dilate as necessary, and this ability is not prejudiced by the presence of the staples.
Zilling
T L
TL
Department of Surgery, Lund University Hospital, Sweden.
Walther
B S
BS
Johnsson
F
F
von Holstein
C S
CS
Oberg
S
S
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D000818:Animals; D001835:Body Weight; D004945:Esophagoscopy; D004947:Esophagus / Q000033:anatomy & histology* / Q000601:surgery*; D005260:Female; D005336:Fiber Optic Technology; D005743:Gastrectomy; D006801:Humans; D007583:Jejunum / Q000033:anatomy & histology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011100:Polyglycolic Acid; D011446:Prospective Studies; D013528:Surgical Staplers; D017792:Surgical Stapling; D013536:Suture Techniques; D013552:Swine
D011100:Polyglycolic Acid