Double-stapling technique for transhiatal distal esophageal resection: feasibility test in a cadaver model.
OBJECTIVE
To assess the feasibility of a new surgical technique for the resection of the distal third of the esophagus and/or cardias for neoplasm.


METHODS
This surgical technique consists of two steps: For this purpose we built a stainless steel support bar for the anvil that is thinner than the freespace of a standard linear suturing stapler (TATM). The support bar holds up a push rod that can be adapted to the hooking-unhooking of the anvil.


RESULTS
We performed our new technique on five cadavers. We did not encounter any difficulty during the procedures. We tested the anastomosis with hydropneumatic assessment without recording any leaks. The esophago-enteric anastomosis was then opened without finding any mechanical defects related to the procedure.


CONCLUSIONS
It can often be very difficult to fashion a safe hand-sewn pouch or a purse string around the anvil of an EEATM during the resection of the distal third of the esophagus or the cardias by a trans-hiatal approach. Moreover, there is no standardized procedure to minimize anastomotic leak. To avoid these mechanical problems we designed this innovative procedure, which is considered to be reproducible without significant training.
Division of General Surgery, University of Eastern Piedmont, Azienda Ospedaliero-Universitaria "Maggiore della Carità" di Novara, Italy.
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Gentilli
Division of Thoracic Surgery, University of Eastern Piedmont, Azienda Ospedaliero-Universitaria "Maggiore della Carità" di Novara, Italy. Electronic address: fab_78_16l@hotmail.com.
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F
Davoli
Division of General Surgery, University of Eastern Piedmont, Azienda Ospedaliero-Universitaria "Maggiore della Carità" di Novara, Italy.
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L
Portigliotti
Division of Pathology, University of Eastern Piedmont, Azienda Ospedaliero-Universitaria "Maggiore della Carità" di Novara, Italy.
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R
Boldorini
Division of Thoracic Surgery, University of Eastern Piedmont, Azienda Ospedaliero-Universitaria "Maggiore della Carità" di Novara, Italy.
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C
Casadio
Division of General Surgery, University of Eastern Piedmont, Azienda Ospedaliero-Universitaria "Maggiore della Carità" di Novara, Italy.
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M
Garavoglia
D000368:Aged; D000714:Anastomosis, Surgical; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017792:Surgical Stapling / Q000379:methods*
Anastomoses; Cancer; Esophagus; Stapler; Transhiatal