title: The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy.
abstract: OBJECTIVE
  To evaluate the safety and feasibility of the triangulating stapling technique (TST) for cervical esophagogastric anastomosis after esophagectomy (CEGA).
  
  
  METHODS
  The subjects were 123 patients who underwent transthoracic esophagectomy with three-field lymph node dissection and reconstruction with a 3.5-cm wide gastric tube, for thoracic esophageal cancer. We performed the TST for CEGA in 33 patients operated on after December, 2006 (TST group) and hand-sewn anastomosis in 90 patients operated on between 2002 and 2006 (HSA group).
  
  
  RESULTS
  In the TST group, CEGA was performed in an end-to-end fashion using three linear staplers. The first anastomosis was applied to the posterior walls of the remnant esophagus and gastric tube in an inverted fashion. The second and the third anastomoses were done in an everted fashion to make the anterior wall. The end-to-end HSA was performed with interrupted sutures using 4-0 absorbable material. Anastomotic leakage occurred in only 1 (3.0%) of the 33 TST patients, but in 13 (14.4%) of the 90 HSA patients (P = 0.07). The frequency of anastomotic stenosis was 9.1% and 25.6% in the TST and HSA groups, respectively (P < 0.05).
  
  
  CONCLUSIONS
  Cervical esophagogastric anastomosis using TST may reduce the frequency of anastomotic leakage and stenosis. This technique is a safe and reliable alternative for CEGA after esophagectomy.
authors.affiliation: Department of Gastroenterological Surgery, National Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan.
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Toh
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Sakaguchi
authors.forename: Osamu
authors.initials: O
authors.lastname: Ikeda
authors.forename: Eisuke
authors.initials: E
authors.lastname: Adachi
authors.forename: Kippei
authors.initials: K
authors.lastname: Ohgaki
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Eiji
authors.initials: E
authors.lastname: Oki
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Minami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okamura
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D019651:Plastic Surgery Procedures; D012449:Safety; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome