21- versus 25-mm Circular Staplers for Cervical Anastomosis: A Propensity-Matched Study

Wang, Jian; Yao, Fei; Yao, Jun; Xu, Liping; Qian, Junling; Shan, Limei

doi:10.1016/j.jss.2019.09.021

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Among the long-term complications associated with EJA, anastomotic stricture is one of the most important, as it affects patient's quality of life and often requires invasive treatment by endoscopic dilation. The frequency of anastomotic strictures in the literature varies from 4.1 to 38% [38][39][40][41][42][43][44][45] APPROVED GALLEY PROOF circular stapler [38], the overall stricture rate was 38%, with differences reported for the various stapler sizes. A higher stricture risk was observed when a 25-mm stapler was used compared with a 28-or 29-mm device (53% vs 23%, respectively).…”

Section: Discussionmentioning

confidence: 99%

“…The decision about stapler size was made intraoperatively, based on the inner diameter of the patient’s esophagus. In some studies there was no difference in strictures rates, comparing 21-mm and 25-mm [ 40 ] or 23–25-mm and 28–33-mm circular staplers [ 39 , 41 , 42 ]. However, a large Japanese cohort [ 43 ], as well as a randomized trial by Fisher et al [ 44 ], reported the use of smaller stapler as a risk factor for stenosis.…”

Section: Discussionmentioning

confidence: 99%

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Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland

et al. 2023

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Background:Mechanical stapling is a commonly used alternative to hand-sewn technique for esophago-jejunal anastomosis in total gastrectomy (TG). Some studies report reduction in postoperative complications in the stapler group. This retrospective study aimed to compare short-and long-term surgical outcomes between the groups with stapled and hand-sewn esophago-jejunal anastomosis (EJA) during open TG for gastric cancer. Material/Methods:The study included 72 adult patients with gastric cancer who underwent TG in the Department of Digestive Tract Surgery in Katowice between May 2018 and December 2021. The patients were divided into 2 groups according to the technique of EJA: stapled (44 cases) or hand-sewn (28 cases). We compared the groups in terms of the duration of the surgery, length of hospital stay, and occurrence of complications (focusing on anastomotic leakage, stricture and abdominal abscess). Results:There were no significant differences in duration of the surgery (P=0.6), blood loss (P=0.7), or length of postoperative hospital stay (P=0.2) among the groups. Early postoperative complications rates were 9.1% (4/44) in the stapler group and 17.9% (5/28) in the hand-sewn group (P=0.27). The most frequent complication was anastomotic leakage, with 2 cases in each group (P=0.76). The mean follow-up time was 1.8±0.9 (0.3-3.6) years. During this period the anastomotic stricture occurred in 7 (15.9%) cases with stapled anastomosis and in 5 (17.9%) cases with hand-sewn anastomosis (P=0.52). Conclusions:In this study there were no significant differences in mortality, morbidity, and surgery duration between stapled and hand-sewn esophago-jejunal anastomosis in total gastrectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland

et al. 2023

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“…The three most widely used anastomotic techniques for esophagogastric anastomosis after esophagectomy are manual anastomosis, circular anastomosis, and linear anastomosis [ 8 ]. Manual anastomosis is the most classic surgical method, which has the advantages of flexible operation and low cost.…”

Section: Discussionmentioning

confidence: 99%

Application of reversely connecting circular stapler technique in cervical esophagogastric anastomosis.

Song¹,

Gao²,

Liu³

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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Introduction:The incidence of anastomotic leakage is relatively high (6-26%) in esophagogastrocervical anastomosis. The traditional anastomotic mode has high tissue tension in the process of anastomosis, which can easily cause tissue tear in the anastomotic area and increase the incidence of anastomotic leakage. Aim: To investigate the usefulness of reversely connecting circular stapler technique for reducing anastomotic tension and injury of the esophageal and gastric wall, preventing anastomotic leakage in minimally invasive McKeown esophagectomy. Material and methods: A total of 133 patients with esophageal cancer who underwent minimally invasive McKeownesophagectomy from January 2021 to December 2021 were collected. Characteristics, surgical data, and outcomes of patients were recorded and retrospectively analyzed. There were 83 patients in the reverse order connecting circular stapler group and 50 patients in the conventional order connecting group. Results: Anastomotic leakage was observed in 2 (2.4%) cases in the reverse order connecting circular stapler group. Compared with the conventional connection group, the reverse connecting group had lower incidence of anastomotic leakage, shorter anastomotic time, shorter hospital stay, and lower incidence of pulmonary and chest infections and hoarseness. Conclusions: The reversely connecting circular stapler technique could reduce the incidence of anastomotic leakage. The technique is simple to perform and easy to learn. Therefore, it is useful for the prevention of anastomotic leakage.

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“…Anastomosis-related complications especially anasomotic leakage is one of the most lethal comorbidies, usually resulting in pyothorax, mediastinitis, tracheal fistula, arterial fistula or septicemia, and ending up with multiple organ failure eventually. In order to achieve satisfactory esophagogastric anastomosis, much effort had been tried either to optimize the anasomotic procedure (18,19,(30)(31)(32)(33)(34)(35)(36)(37), to better off the blood flow at the anastomotic site on the grafted conduits (11,38,39), or to manage prophylactic measurements to ensure the confinement of inflammation and facilitate the healing in case of leakage (20,21). In the present study we evaluated the utility of MOMA and compared it with CDHA in cervical esophagogastric anastomosis after sub-total esophagectomy in TE-SCC patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

et al. 2021

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The present study aimed to introduce a novel method of cervical esophagogastric anastomosis, so-called 'modified one-piece mechanical anastomosis' (MOMA) in McKeown esophagogastrectomy and to compare its feasibility, efficacy and safety with those of 'conventionally double-layer hand-sewn anastomosis' (CDHA). Between March 2016 and March 2018, 80 consecutive patients with thoracic esophageal squamous cell carcinoma undergoing McKeown esophagogastrectomy with a curative intent were included in the present study. Among them, 40 received MOMA and the other 40 received CDHA. Their medical records, including operation time, anastomotic time, estimated blood loss, postoperative complications within 30 days, as well as survival rate, were retrospectively reviewed, analyzed and compared. Total operation time, anastomotic time and estimated blood loss in the MOMA group were significantly decreased compared with those in the CDHA group (207.73±2.66 vs. 225.40±3.43 min; 10.95±0.44 vs. 23.03±0.47 min; 144.50±21.14 vs. 241.75±23.75 ml; all P<0.01). Anastomotic leakage was present in 1 patient in the CDHA group, but no patients in the MOMA group (P=1.000). Anastomotic stenosis was documented in 4 and 2 patients in the MOMA and CDHA group, respectively (P=0.392). The 30-day operative mortality was 0% and no significant difference was demonstrated in postoperative complications within groups (P>0.05). Furthermore, the disease-free and overall survival was compared by means of Kaplan-Meier survival estimates and log-rank tests and no statistical difference was determined (P=0.5114 and P=0.7875, respectively). McKeown esophagogastrectomy with MOMA may be a feasible, effective and reproducible alternative with relatively satisfactory postoperative outcomes for the treatment of TE-SCC, providing shorter operation and anastomosis times, and less estimated intraoperative blood loss.

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21- versus 25-mm Circular Staplers for Cervical Anastomosis: A Propensity-Matched Study

Cited by 6 publications

References 24 publications

Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland

Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland

Application of reversely connecting circular stapler technique in cervical esophagogastric anastomosis.

Comparison of a modified one‑piece mechanical and double‑layer hand‑sewn anastomosis in McKeown esophagogastrectomy: A single‑institute retrospective study

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