Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy

Since November 1980, the EEA stapling device has been used to create an end-to-side esophagojejunostomy in 238 patients who underwent total gastrectomy. Failures in the stapling technique were divided into two groups: immediate and delayed. Immediate failures were observed and corrected at the time of surgery. In ten cases, the muscular layer of the esophagus was disrupted, and in three the mucosal layer of the jejunum was disrupted. There were 18 delayed complications: eight cases of anastomotic leakage (3.4%), and ten of stenosis (4.2%). The leakage in one case was classified as major, and those in the other seven as minor. Of the ten stenosis cases, there were five of membranous stricture, four of granular stricture, and one of narrowing after major leakage healing. Only this last case required further surgical treatment. The other nine were successfully dilated either endoscopically or by bougienage.