Circular Stapler Method for Avoiding Stricture of Cervical Esophagogastric Anastomosis

• Published in: Journal of gastrointestinal surgery 2022-04, Vol.26 (4), p.725-732
• Main Authors: Shiraishi, Osamu, Yasuda, Takushi, Kato, Hiroaki, Momose, Kota, Hiraki, Yoko, Yasuda, Atsushi, Shinkai, Masayuki, Imano, Motohiro
• Format: Article
• Language: English
• Subjects: Anastomosis, Surgical - adverse effects; Anastomosis, Surgical - methods; Anastomotic Leak - epidemiology; Anastomotic Leak - etiology; Anastomotic Leak - prevention & control; Constriction, Pathologic - etiology; Constriction, Pathologic - prevention & control; Constriction, Pathologic - surgery; Esophageal cancer; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Gastroenterology; Gastrointestinal surgery; Humans; Medicine; Medicine & Public Health; Original Article; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - prevention & control; Surgery; Surgical anastomosis; Surgical Stapling - adverse effects; Surgical techniques; Treatment Outcome
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-022-05266-4

Background This study was performed to verify the superiority of a new “non-tensioning method” for avoiding stricture of the cervical esophagogastric anastomosis by circular stapling compared with the conventional method. Methods In total, 395 consecutive patients who underwent McKeown esophagectomy with gastric conduit (GC) reconstruction were reviewed. A 4 cm-wide GC was created and pulled up at the cervical site through the retrosternal route. The esophagogastrostomy site of the GC was planned as far caudally as possible on the greater curvature side. In the conventional technique, the stapler was fired while pulling the GC to avoid tissue slack. In the non-tensioning technique, the stapler was fired through the natural thickness of the stomach wall. The length of the blind end was changed from 4 to 2 cm in the non-tensioning technique. Anastomotic leakage and stricture formation were compared between the two techniques, and adjustment was performed using propensity score matching. Results The conventional group comprised 315 patients, and the non-tensioning group comprised 80 patients. Anastomotic leakage occurred in 22 (7%) and 2 (2.5%) patients, respectively ( P  = 0.134) [and in 9 (2.9%) and 2 (2.5%) patients, respectively, if leakage at the blind end was excluded]. Anastomotic stricture occurred in 92 (29.2%) and 3 (3.8%) patients, respectively ( P