The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy

Yasushi Toh, Yoshihisa Sakaguchi, Osamu Ikeda, Eisuke Adachi, Kippei Ohgaki, Yoichi Yamashita, Eiji Oki, Kazuhito Minami, Takeshi Okamura

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Abstract

Purpose: To evaluate the safety and feasibility of the triangulating stapling technique (TST) for cervical esophagogastric anastomosis after esophagectomy (CEGA). Methods: The subjects were 123 patients who underwent transthoracic esophagectomy with three-field lymph node dissection and reconstruction with a 3.5-cm wide gastric tube, for thoracic esophageal cancer. We performed the TST for CEGA in 33 patients operated on after December, 2006 (TST group) and hand-sewn anastomosis in 90 patients operated on between 2002 and 2006 (HSA group). Results: In the TST group, CEGA was performed in an end-to-end fashion using three linear staplers. The first anastomosis was applied to the posterior walls of the remnant esophagus and gastric tube in an inverted fashion. The second and the third anastomoses were done in an everted fashion to make the anterior wall. The end-to-end HSA was performed with interrupted sutures using 4-0 absorbable material. Anastomotic leakage occurred in only 1 (3.0%) of the 33 TST patients, but in 13 (14.4%) of the 90 HSA patients (P = 0.07). The frequency of anastomotic stenosis was 9.1% and 25.6% in the TST and HSA groups, respectively (P < 0.05). Conclusions: Cervical esophagogastric anastomosis using TST may reduce the frequency of anastomotic leakage and stenosis. This technique is a safe and reliable alternative for CEGA after esophagectomy.

Original languageEnglish
Pages (from-to)201-206
Number of pages6
JournalSurgery today
Volume39
Issue number3
DOIs
Publication statusPublished - Mar 1 2009

All Science Journal Classification (ASJC) codes

  • Surgery

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    Toh, Y., Sakaguchi, Y., Ikeda, O., Adachi, E., Ohgaki, K., Yamashita, Y., Oki, E., Minami, K., & Okamura, T. (2009). The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surgery today, 39(3), 201-206. https://doi.org/10.1007/s00595-008-3827-2