Side-to-side stapled intra-thoracic esophagogastric anastomosis reduces the incidence of leaks and stenosis |
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Authors: | D J Raz P Tedesco F A M Herbella I Nipomnick L W Way M G Patti |
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Institution: | Department of Surgery, University of California San Francisco |
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Abstract: | SUMMARY. Trans-hiatal esophagectomy with a hand-sewn anastomosis was for 2 decades the preferred approach in our institution for patients with esophageal cancer. In our experience, this anastomotic technique was associated with a 12% leak rate and a 48% rate of stricture requiring dilatation. We sought to determine if a side-to-side intra-thoracic anastomosis was associated with a lower rate of anastomotic stricture and leak. Thirty-three consecutive patients with distal esophageal cancer or Barrett's esophagus with high grade dysplasia underwent a trans-thoracic esophagectomy with a side-to-side stapled intra-thoracic anastomosis. The overall morbidity was 27%, with no anastomotic stricture or leaks. One patient died (3%). The median time to the resumption of an oral diet was 7 days (range 5–28), and the median length of stay in hospital was 9 days (range 6–45). Trans-thoracic esophagectomy with a side-to-side stapled anastomosis is safe and it is associated with a very low rate of anastomotic complications. We consider this to be the procedure of choice for patients with distal esophageal cancers. |
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Keywords: | anastomotic leak anastomotic stricture esophageal cancer esophagogastric anastomosis trans-hiatal esophagectomy trans-thoracic esophagectomy |
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