title: Reconstruction of the jejunoesophageal anastomosis with a circular mechanical stapler in total laryngopharyngectomy defects.
abstract: BACKGROUND
  The aim of this study was to demonstrate the technical feasibility and potential benefits of using a circular mechanical stapler with free jejunal transfer for jejunoesophageal anastomosis in total laryngopharyngectomy reconstruction while comparing the rates of fistula and stricture.
  
  
  METHODS
  This study was a retrospective review of 12 free jejunal flaps completed with circular mechanical stapler for the jejunoesophageal anastomosis with comparison to 17 jejunal free flaps where all anastomoses were hand sewn.
  
  
  RESULTS
  In all, 29 patients underwent free jejunal transfer: 12 had jejunal free flap with circular mechanical stapler for jejunoesophageal anastomosis, whereas 17 patients had hand-sewn anastomosis. Corresponding rates of fistula and stricture were 0/12 fistulas and 3/12 strictures in the stapler cohort and 2/17 fistulas with 0/17 strictures in the hand-sewn cohort. No statistically significant difference in rate of fistula was observed between each cohort, whereas a trend toward increased rate of stricture (p = .06) was observed in the stapled anastomosis cohort.
  
  
  CONCLUSIONS
  Use of circular mechanical stapler appears to be a safe and effective technique at the jejunoesophageal anastomosis for total laryngopharyngeal defects with comparable fistula and stricture rates to grafts that are hand sewn.
authors: Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Science University, Portland, Oregon, USA. schnedan@ohsu.edu
authors: Daniel S
authors: DS
authors: Schneider
authors: Neil D
authors: ND
authors: Gross
authors: Brett C
authors: BC
authors: Sheppard
authors: Mark K
authors: MK
authors: Wax
mesh_terms: D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods*; D004937:Esophageal Fistula / Q000209:etiology; D004940:Esophageal Stenosis / Q000209:etiology; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D007583:Jejunum / Q000601:surgery* / Q000637:transplantation; D007825:Laryngectomy; D008297:Male; D010611:Pharyngectomy; D012189:Retrospective Studies; D013528:Surgical Staplers; D013536:Suture Techniques; D013537:Sutures