A free peritoneal patch does not affect the leakage rate but increases stricture formation of a cervical esophagogastrostomy.
BACKGROUND
Healing of a cervical esophagogastrostomy is frequently impaired, resulting in a higher incidence of leakage and stricture formation, as compared to an intrathoracic anastomosis. Lack of mesothelial factors is hypothesized to contribute to this impaired anastomotic healing. The aim of this prospective study was to determine whether a free peritoneal patch around a cervical esophagogastrostomy can improve anastomotic healing.


METHODS
In 23 consecutive patients a free peritoneal patch was fixed around a cervical esophagogastrostomy. Results were compared to those of a historical control group of 41 patients. Clinical and/or radiographic leakage and stenosis requiring endoscopic dilatation were used as endpoints.


RESULTS
Three patients died in the early postoperative period (in-hospital mortality 3/64 = 5%). Leakage rate was 13% (3/23) in the group with a patch and 15% (6/41) in the control group (p = 0.90). At 6-month follow-up, the incidence of stenosis was significantly higher (65%) in the group with a patch, compared to 31% in the control group (p = 0.02).


CONCLUSIONS
A peritoneal patch does not affect the leakage rate but increases the incidence of postoperative stenosis of a cervical esophagogastrostomy. Therefore, its clinical application is contraindicated.
van Oosterom
F J
FJ
Department of Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands.
van Lanschot
J J
JJ
Oosting
J
J
Obertop
H
H
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000379:methods; D004940:Esophageal Stenosis / Q000209:etiology*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck; D010537:Peritoneum; D011183:Postoperative Complications