title: Side-to-side stapled intra-thoracic esophagogastric anastomosis reduces the incidence of leaks and stenosis.
abstract: Trans-hiatal esophagectomy with a hand-sewn anastomosis was for 2 decades the preferred approach in our institution for patients with esophageal cancer. In our experience, this anastomotic technique was associated with a 12% leak rate and a 48% rate of stricture requiring dilatation. We sought to determine if a side-to-side intra-thoracic anastomosis was associated with a lower rate of anastomotic stricture and leak. Thirty-three consecutive patients with distal esophageal cancer or Barrett's esophagus with high grade dysplasia underwent a trans-thoracic esophagectomy with a side-to-side stapled intra-thoracic anastomosis. The overall morbidity was 27%, with no anastomotic stricture or leaks. One patient died (3%). The median time to the resumption of an oral diet was 7 days (range 5-28), and the median length of stay in hospital was 9 days (range 6-45). Trans-thoracic esophagectomy with a side-to-side stapled anastomosis is safe and it is associated with a very low rate of anastomotic complications. We consider this to be the procedure of choice for patients with distal esophageal cancers.
authors.affiliation: Department of Surgery, University of California, San Francisco, CA 94143-0788, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Raz
authors.forename: P
authors.initials: P
authors.lastname: Tedesco
authors.forename: F A M
authors.initials: FA
authors.lastname: Herbella
authors.forename: I
authors.initials: I
authors.lastname: Nipomnick
authors.forename: L W
authors.initials: LW
authors.lastname: Way
authors.forename: M G
authors.initials: MG
authors.lastname: Patti
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000714:Anastomosis, Surgical / Q000379:methods*; D001471:Barrett Esophagus / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000601:surgery; D003251:Constriction, Pathologic / Q000517:prevention & control; D004938:Esophageal Neoplasms / Q000601:surgery; D016629:Esophagectomy / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D013270:Stomach / Q000601:surgery*; D017792:Surgical Stapling