Side-to-side stapled intra-thoracic esophagogastric anastomosis reduces the incidence of leaks and stenosis

• Published in: Diseases of the esophagus Vol. 21; no. 1; pp. 69 - 72
• Main Authors: Raz, D. J., Tedesco, P., Herbella, F. A. M., Nipomnick, I., Way, L. W., Patti, M. G.
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.02.2008
• Subjects: Adenocarcinoma - surgery; Anastomosis, Surgical - methods; anastomotic leak; anastomotic stricture; Barrett Esophagus - surgery; Carcinoma, Squamous Cell - surgery; Constriction, Pathologic - prevention & control; esophageal cancer; Esophageal Neoplasms - surgery; Esophagectomy - methods; esophagogastric anastomosis; Esophagus - surgery; Female; Humans; Length of Stay; Male; Middle Aged; Postoperative Complications - prevention & control; Stomach - surgery; Surgical Stapling; trans-hiatal esophagectomy; trans-thoracic esophagectomy
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/j.1442-2050.2007.00736.x

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.