Utility of total mechanical stapled cervical esophagogastric anastomosis after esophagectomy: a comparison to conventional anastomotic techniques.

Background: Cervical esophagogastric anastomosis after esophagectomy is often troubled with anastomotic leak resulting in local sepsis, postoperative stricture, and prolonged hospitalization. We compared the anastomotic outcomes and clinical course of esophagectomy patients undergoing total mechanical stapled esophagogastric anastomosis versus a partial handsewn/mechanical stapled cervical anastomotic technique.

Methods: One hundred eighty-one patients underwent transhiatal (N=146) or 3-field (abdomen/chest/neck incisions) (N=35) esophagectomy. A total mechanical stapled anastomosis was accomplished in 125 patients. A handsewn/mechanical stapled anastomosis was performed in 56 patients. The total mechanical stapled anastomosis was accomplished by using the endoscopic gastrointestinal stapler to construct the posterolateral aspect and a linear stapler to close the anterior aspect of the anastomosis. Total mechanical stapled anastomosis patients had the endoscopic gastrointestinal stapler also used to divide the left gastric vessels and the short gastric mesentery for gastric mobilization. Anastomotic outcomes were analyzed by the leak rate (contrast study) and the need of serial dilations in each group.

Conclusions: Total mechanical stapled technique after esophagectomy with cervical esophagogastric anastomosis appears to be effective in reducing hospitalization and anastomotic complications compared to partial or complete handsewn techniques. Liberal use of endoscopic staplers might shorten operative time. Esophageal surgeons should be aware of the advantages and become skilled with these techniques.