Esophagogastric anastomosis with invagination into stomach: New technique to reduce fistula formation.
OBJECTIVE
To present a new technique of cervical esophagogastric anastomosis to reduce the frequency of fistula formation.


METHODS
A group of 31 patients with thoracic and abdominal esophageal cancer underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube. In the region elected for anastomosis, a transverse myotomy of the esophagus was carried out around the entire circumference of the esophagus. Afterwards, a 4-cm long segment of esophagus was invaginated into the stomach and anastomosed to the anterior and the posterior walls.


RESULTS
Postoperative minor complications occurred in 22 (70.9%) patients. Four (12.9%) patients had serious complications that led to death. The discharge of saliva was at a lower region, while attempting to leave the anastomosis site out of the alimentary transit. Three (9.7%) patients had fistula at the esophagogastric anastomosis, with minimal leakage of air or saliva and with mild clinical repercussions. No patients had esophagogastric fistula with intense saliva leakage from either the cervical incision or the thoracic drain. Fibrotic stenosis of anastomoses occurred in seven (22.6%) patients. All these patients obtained relief from their dysphagia with endoscopic dilatation of the anastomosis.


CONCLUSIONS
Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula with mild clinical repercussions.
Department of Surgery, University Hospital, ABC Medical School, Avenida Lauro Gomes 2000, Santo André, São Paulo, 09060-870, Brazil.
Alexandre Cruz
AC
Henriques
Carlos Alberto
CA
Godinho
Roberto
R
Saad
Daniel Reis
DR
Waisberg
Aline Biral
AB
Zanon
Manlio Basilio
MB
Speranzini
Jaques
J
Waisberg
D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001938:Brazil; D003680:Deglutition Disorders / Q000209:etiology / Q000628:therapy; D004106:Dilatation; D016099:Endoscopy, Gastrointestinal; D004937:Esophageal Fistula / Q000209:etiology / Q000517:prevention & control*; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000628:therapy; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D005747:Gastric Fistula / Q000209:etiology / Q000517:prevention & control*; D015391:Gastroplasty / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome