Experience and technique of stapled mechanical cervical esophagogastric anastomosis.
BACKGROUND
Anastomotic leak from cervical esophagogastric anastomoses is a serious problem after esophagectomy. We explored the efficacy of partial or total mechanical anastomoses accomplished with the endoscopic linear cutting and stapling device as an alternative to hand-sewn anastomotic techniques.


METHODS
During a 42-month period, 93 patients undergoing either transhiatal esophagectomy or a three-incisional approach to esophagectomy underwent either hand-sewn (n = 43), partial mechanical (n = 16), or totally mechanical (n = 34) cervical esophagogastric anastomoses. The occurrence of postoperative anastomotic leak and the development of postoperative anastomotic stricturing requiring dilation therapy were analyzed between these groups using chi2.


RESULTS
All patients survived esophagectomy and were available for postoperative follow-up. Anastomotic leak developed in 10 patients (23%) with hand-sewn, 1 patient (6%) with partial mechanical, and 1 patient (3%) with total mechanical anastomoses (p < 0.05). Anastomotic stricture development paralleled the occurrence of anastomotic leak rate with 25 patients (58%) with hand-sewn, 3 patients (19%) with partial mechanical, and 6 patients (18%) with total mechanical anastomoses experiencing strictures requiring dilation therapy (p < 0.05).


CONCLUSIONS
These results suggest that partial or mechanical cervical esophagogastric anastomoses created with the endoscopic stapling device may be superior to hand-sewn anastomotic techniques.
Division of General Thoracic Surgery, Allegheny General Hospital, University of Pittsburgh, Pennsylvania 15212-4772, USA.
D
D
Singh
R H
RH
Maley
T
T
Santucci
R S
RS
Macherey
S
S
Bartley
R J
RJ
Weyant
R J
RJ
Landreneau
D000230:Adenocarcinoma / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000379:methods*; D004945:Esophagoscopy / Q000379:methods; D006801:Humans; D012307:Risk Factors; D013270:Stomach / Q000601:surgery*; D013528:Surgical Staplers; D013529:Surgical Wound Dehiscence / Q000209:etiology