title: Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture: a comparative clinical study.
abstract: OBJECTIVE
  The aim of this study was to retrospectively compare the operative effects of linear stapled intrathoracic esophagogastrostomy with hand-sewn or circular stapled anastomosis in prevention of anastomotic stricture.
  
  
  METHODS
  Between October 2007 and October 2009, 293 patients with esophageal or gastric cardia cancer underwent a curative intent resection. Patients received either a linear stapled (LS group, n = 166), conventional hand-sewn (HS group, n = 59), or circular stapled intrathoracic esophagogastric anastomosis (CS group, n = 68). The patients were followed-up and compared at 3 months after the operation.
  
  
  RESULTS
  Three groups of patients were comparable on clinical baseline characteristics. There was one operative death in the HS group. The operative complications were documented in 15 patients (5.1%), with no difference among three groups (χ(2) = 2.215, P = 0.330). The follow-up rate was 96.9%. The anastomotic diameter was 1.6 ± 0.4 cm in the LS group, 1.2 ± 0.3 cm in the HS group, and 1.0 ± 0.4 cm in the CS group, respectively (F = 58.110, P < 0.001). The anastomotic stricture rates were 1.9% (3/162) in the LS group, 9.3% (5/54) in the HS group, and 20.9% (14/67) in the CS group, respectively (χ(2) = 24.095, P < 0.001). The reflux score in LS group was lower than other two groups (H = 6.995, P = 0.030).
  
  
  CONCLUSIONS
  The linear stapled esophagogastrostomy could decrease anastomotic stricture without increasing gastroesophageal reflux.
authors.affiliation: Department of Thoracic Surgery, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China.
authors.forename: Qi-Rong
authors.initials: QR
authors.lastname: Xu
authors.forename: Kang-Ning
authors.initials: KN
authors.lastname: Wang
authors.forename: Wen-Ping
authors.initials: WP
authors.lastname: Wang
authors.forename: Kun
authors.initials: K
authors.lastname: Zhang
authors.forename: Long-Qi
authors.initials: LQ
authors.lastname: Chen
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D057868:Anastomotic Leak / Q000209:etiology; D002277:Carcinoma / Q000601:surgery*; D002299:Cardia / Q000601:surgery*; D016009:Chi-Square Distribution; D003251:Constriction, Pathologic / Q000209:etiology / Q000517:prevention & control; D003680:Deglutition Disorders / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000209:etiology / Q000517:prevention & control*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000601:surgery*; D013528:Surgical Staplers; D017792:Surgical Stapling / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D013536:Suture Techniques / Q000009:adverse effects