title: Clinical application of layered anastomosis during esophagogastrostomy.
abstract: The aim of this study was to compare the operative results in regard to reducing anastomotic leakage and stricture formation using a newly designed layered manual esophagogastric anastomosis versus a stapler esophagogastrostomy versus the conventional hand-sewn whole-layer anastomosis after resection for esophageal or gastric cardiac carcinoma. From January 2004 to September 2006, a total of 1024 patients with esophageal or gastric cardia carcinoma underwent a layered esophagogastric anastomosis with the assistance of a three-leaf clipper in a single university medical center. The mucosal layers of the esophagus and stomach were sutured continuously with 4/0 Vicryl plus antibacterial suture (polyglyconate). From May 2002 to December 2003, there were also 170 patients and 69 patients who underwent stapler and conventional whole-layer anastomosis, respectively; they served as control groups. The results were analyzed retrospectively. The operative mortality rate was 0.7% in the layered group compared to 5.9% and 7.2% for the stapler group and the whole-layer group (p < 0.01), The anastomotic leakage rates were 0%, 3.5%, and 5.8% for the layered group, stapler group, and whole-layer group, respectively (p < 0.01). All patients were followed postoperatively. Six patients in the layered group (0.6%) developed mild stricture formation compared to 16 patients in stapled group (9.9%) and 5 patients in the conventional whole-layer group (7.8%) (p < 0.01). The application of layered esophagogastric anastomosis could reduce the incidence of anastomotic leakage and stricture after esophagectomy compared with the stapler and whole-layer manual anastomoses. It is easy to apply and could be used as an alternative for esophagogastric anastomosis after resection for esophageal or cardiac carcinoma.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu, Sichuan 610041, China. zhuzijiang2005@sina.com
authors.forename: Zi-Jiang
authors.initials: ZJ
authors.lastname: Zhu
authors.forename: Yong-Fan
authors.initials: YF
authors.lastname: Zhao
authors.forename: Long-Qi
authors.initials: LQ
authors.lastname: Chen
authors.forename: Yang
authors.initials: Y
authors.lastname: Hu
authors.forename: Lun-Xu
authors.initials: LX
authors.lastname: Liu
authors.forename: Yun
authors.initials: Y
authors.lastname: Wang
authors.forename: Ying-Li
authors.initials: YL
authors.lastname: Kou
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D016022:Case-Control Studies; D004938:Esophageal Neoplasms / Q000601:surgery; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery; D013528:Surgical Staplers; D013536:Suture Techniques / Q000009:adverse effects; D016896:Treatment Outcome