title: End-to-end cervical esophagogastric anastomoses are associated with a higher number of strictures compared with end-to-side anastomoses.
abstract: BACKGROUND
  Leakage and benign strictures occur frequently after esophagectomy. The objective of this study was to analyze the outcome of hand-sewn end-to-end versus end-to-side cervical esophagogastric anastomoses.
  
  
  METHODS
  A series of 390 consecutive patients who underwent esophagectomy with gastric conduit reconstruction was analyzed.
  
  
  RESULTS
  The end-to-end technique was performed in 112 (29 %) patients and the end-to-side in 278 (71 %) patients. Anastomotic leakage occurred in 20 (18 %) patients with an end-to-end anastomosis versus 58 (21 %) patients with an end-to-side anastomosis (p = 0.50). A higher incidence in anastomotic strictures was seen in end-to-end anastomoses (48 (43 %)) compared with end-to-side anastomoses (89 (32 %); p = 0.04). Moreover, a median of 11 (7-17) dilations was necessary in patients with a benign anastomotic stricture in the end-to-end group compared with four (2-8) dilations in patients with a benign anastomotic stricture in the end-to-end group (p < 0.036). After multivariate analysis, the difference in anastomotic leakage rates remained nonsignificant (p = 0.74), whereas anastomotic stricture rate and number of dilations were higher in the end-to-end group (p = 0.03 and p = 0.01, respectively).
  
  
  CONCLUSIONS
  The technique of anastomosis is not significantly related to anastomotic leakage rate. However, patients with end-to-end anastomoses develop postoperative strictures more frequently, requiring a higher number of dilations compared to end-to-side anastomoses.
authors: Department of Surgery, University Medical Centre Utrecht, 3508 GA, Utrecht, The Netherlands.
authors: Leonie
authors: L
authors: Haverkamp
authors: Pieter C
authors: PC
authors: van der Sluis
authors: Roy J J
authors: RJ
authors: Verhage
authors: Peter D
authors: PD
authors: Siersema
authors: Jelle P
authors: JP
authors: Ruurda
authors: Richard
authors: R
authors: van Hillegersberg
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000453:epidemiology*; D016009:Chi-Square Distribution; D004938:Esophageal Neoplasms / Q000601:surgery*; D004940:Esophageal Stenosis / Q000453:epidemiology*; D016629:Esophagectomy / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology*; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
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