title: Anastomotic complications associated with stapled versus hand-sewn anastomosis.
abstract: OBJECTIVE
  To compare anastomotic complications of stapled versus hand-sewn cervical esophago-gastric anastomosis.
  
  
  METHODS
  All patients undergoing esophageal resection are entered into a prospectively maintained database. The database was queried to identify patients who had near total esophagectomy with cervical esophago-gastric anastomosis. The effect of anastomotic technique and surgeon experience on anastomotic complications, leak, and stricture were analyzed.
  
  
  RESULTS
  Eighty-one patients underwent open or minimally invasive esophagectomy and gastric pull-up with or without thoracic mobilization. Eighteen patients had hand-sewn anastomosis and 63 had a partially stapled anastomosis. There was no significant difference between leak rate (22% (4/18) versus 7% (5/63) P = 0.09) and anastomotic stricture rate (38% (7/18) versus 26% (17/63), P = 0.34) between the two groups. Dividing the experience chronologically into three groups of 27 reveals a trend towards decreased leak rate with experience. The leak rate was only 3.7 % (1/27) in the most recent group compared with 14.8% (4/27) in the first group (P = 0.17).
  
  
  CONCLUSIONS
  In our experience, there was no significant difference in anastomotic complications between hand-sewn and stapled anastomosis. However, there is a decreasing trend in anastomotic complications with increasing surgeon experience.
authors.affiliation: Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska 68187, USA.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Worrell
authors.forename: Seemal
authors.initials: S
authors.lastname: Mumtaz
authors.forename: Kazuto
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Tommy H
authors.initials: TH
authors.lastname: Lee
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects* / Q000379:methods; D004940:Esophageal Stenosis / Q000209:etiology*; D016629:Esophagectomy; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D013537:Sutures / Q000009:adverse effects*