title: A new three-layer-funnel-shaped esophagogastric anastomosis for surgical treatment of esophageal carcinoma.
abstract: OBJECTIVE
  To reduce the incidence of postoperative anastomotic leak, stenosis, gastroesophageal reflux (GER) for patients with esophageal carcinoma, and to evaluate the conventional method of esophagectomy and esophagogastroplasty modified by a new three-layer-funnel-shaped (TLF) esophagogastric anastomotic suturing technique.
  
  
  METHODS
  From January 1997 to October 1999, patients with clinical stage I and II (IIa and IIb) esophageal carcinoma, which met the enrollment criteria, were surgically treated by the new method (Group A) and by conventional operation (Group B). All the patients were followed at least for 6 months. Postoperative outcomes and complications were recorded and compared with the conventional method in the same hospitals and with that reported previously by McLarty et al in 1997 (Group C).
  
  
  RESULTS
  58 cases with stage I and II (IIa and IIb) esophageal carcinoma, including 38 males and 20 females aged from 34 to 78 (mean age: 57), were surgically treated by the TLF anastomosis and 64 by conventional method in our hospitals from January 1997 to October 1999. The quality of swallowing was improved significantly (Wilcoxon W=2 142, P=0.0 001) 2 to 3 months after the new operation in Group A. Only one patient had a blind anastomatic fistula diagnosed by barium swallow test 2 months but healed up 3 weeks later. Postoperative complications occurred in 25 (43 %) patients, anastomotic stenosis in 8 (14 %), and GER in 13 (22 %). The incidences of postoperative anastomotic leak, stenosis and GER were significantly decreased by the TLF anastomosis method compared with that of conventional methods (chi(2)=6.566, P=0.038; chi(2)=10.214, P=0.006; chi(2)=21.265, P=0.000).
  
  
  CONCLUSIONS
  The new three-layer-funnel-shaped esophagogastric anastomosis (TLFEGA) has more advantages to reduce postoperative complications of anastomotic leak, stricture and GER.
authors.affiliation: Research Institute of Digestive Disease, South Hospital, First Military Medical University, Guangzhou 510515, Guangdong Province, China. henrydan@sina.com
authors.forename: Han-Lei
authors.initials: HL
authors.lastname: Dan
authors.forename: Yang
authors.initials: Y
authors.lastname: Bai
authors.forename: Hui
authors.initials: H
authors.lastname: Meng
authors.forename: Cong-Lin
authors.initials: CL
authors.lastname: Song
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.forename: Yong
authors.initials: Y
authors.lastname: Zhang
authors.forename: Lei-Chi
authors.initials: LC
authors.lastname: Wan
authors.forename: Ya-Li
authors.initials: YL
authors.lastname: Zhang
authors.forename: Zhen-Shu
authors.initials: ZS
authors.lastname: Zhang
authors.forename: Dian-Yuan
authors.initials: DY
authors.lastname: Zhou
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D004938:Esophageal Neoplasms / Q000473:pathology / Q000601:surgery*; D004947:Esophagus / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications; D013270:Stomach / Q000601:surgery