Esophageal anastomosis following gastrectomy for gastric cancer: comparison of hand-sewn and stapling technique.
OBJECTIVE
During the past 4 years, we have experienced a marked reduction in the incidence of esophageal anastomotic leakage and/or stricture coinciding with the use of a mechanical circular stapler for gastric cancer patients.


METHODS
We reviewed medical records of gastric cancer patients who underwent a total or proximal gastrectomy, and compared the leakage or stricture of stapled anastomosis with the hand-sewn anastomosis technique. A total of 390 esophageal anastomosis were performed between January 1978 and August 1997. Two types of mechanical circular staplers were used (EEA and CDH).


RESULTS
Anastomotic leakage occurred in 13 (3.3%) of 390 cases; three (4.5%) of 66 cases with hand-sewn anastomosis, and 10 (3.1%) of 324 cases with stapled anastomosis (EEA: 4.5%, CDH: 0%). The anastomotic leakage rate was significantly lower in the CDH stapler group than in the EEA stapler group. Anastomotic stricture occurred in one (1.5%) of 66 cases of hand-sewn anastomosis, and 16 (4.9%) of 324 cases of stapled anastomosis (EEA: 5.9%, CDH: 2.9%). There were no significant differences in the stricture rate between the hand-sewn group and the stapler group.


CONCLUSIONS
Stapling anastomosis using a CDH stapler led to a reduction in the incidence of anastomotic leakage. Surgeons must, however, continue to be aware of anastomotic stricture.
Takeyoshi
I
I
Second Department of Surgery, Gunma University School of Medicine, Japan.
Ohwada
S
S
Ogawa
T
T
Kawashima
Y
Y
Ohya
T
T
Kawate
S
S
Arai
K
K
Nakasone
Y
Y
Morishita
Y
Y
D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D016009:Chi-Square Distribution; D004947:Esophagus / Q000601:surgery*; D005743:Gastrectomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D017792:Surgical Stapling; D013536:Suture Techniques; D016896:Treatment Outcome