title: Simple Technique of Circular Stapled Anastomosis in Ivor Lewis Esophagectomy.
abstract: BACKGROUND
  Advent of minimally-invasive esophagectomy necessitated the incorporation of stapled anastomotic techniques especially for intrathoracic anastomosis. We present our approach to the Ivor Lewis esophagectomy highlighting a simple modification in the anastomotic technique and review our experience with anastomotic outcomes.
  
  
  METHODS
  With IRB approval, patients who underwent Ivor Lewis esophagectomy with circular-stapled end-to-end anastomosis (EEA) were identified, divided into three equal sequential cohorts (A, B, and C), and compared for perioperative outcome. Cohorts were divided in a chronological order to have equal number of patients in each group.
  
  
  RESULTS
  Seventy-five patients underwent Ivor Lewis esophagectomy with circular stapled (EEA-25/28) anastomosis. Group A had longer median postoperative hospital stay and median postoperative ICU stay compared to Groups B and C. Ten patients (13%) had anastomotic leak-one patient required redo-anastomosis and other patients were managed with endoscopic interventions. There was significant decrease in rate of anastomotic leak with experience (8 versus 1 versus 1, P = .004). There were two perioperative deaths, one each in Groups A and C, including one death due to anastomotic leak (Group A).
  
  
  CONCLUSIONS
  Use of simple modifications to stapled EEA, as described here, has led to decrease in anastomotic leaks following Ivor Lewis esophagectomy.
authors.affiliation: 1 Norton Thoracic Institute, Dignity Health, Creighton University School of Medicine , Phoenix, Arizona.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Singhal
authors.affiliation: 2 Department of Surgery, Creighton University School of Medicine , Creighton Univesity Medical Center, Omaha, Nebraska.
authors.forename: Aparna
authors.initials: A
authors.lastname: Kailasam
authors.affiliation: 2 Department of Surgery, Creighton University School of Medicine , Creighton Univesity Medical Center, Omaha, Nebraska.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Akimoto
authors.affiliation: 1 Norton Thoracic Institute, Dignity Health, Creighton University School of Medicine , Phoenix, Arizona.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Masuda
authors.affiliation: 2 Department of Surgery, Creighton University School of Medicine , Creighton Univesity Medical Center, Omaha, Nebraska.
authors.forename: Carrie
authors.initials: C
authors.lastname: Bertellotti
authors.affiliation: 1 Norton Thoracic Institute, Dignity Health, Creighton University School of Medicine , Phoenix, Arizona.|2 Department of Surgery, Creighton University School of Medicine , Creighton Univesity Medical Center, Omaha, Nebraska.
authors.forename: Sumeet K
authors.initials: SK
authors.lastname: Mittal
mesh_terms: D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000453:epidemiology / Q000517:prevention & control; D016629:Esophagectomy / Q000379:methods*; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome
keywords: EEA; Ivor Lewis esophagectomy; anastomotic leak; circular-stapled anastomosis; esophagectomy