Comparison of a single layer continuous hand-sewn method and circular stapling in 580 oesophageal anastomoses

Abstract

A total of 611 patients with carcinoma of the oesophagus or gastric cardia were operated on between July 1982 and December 1989. Resection was performed in 491 patients (one-stage, 483; two-stage, eight), bypass operation in 97, and 23 had exploration alone. The anastomoses of 580 patients with one-stage resection and bypass operations were evaluated. Hand-sewn anastomosis using a single layer of continuous absorbable monofilament suture was performed in 304 patients (221 resections and 83 bypasses). A stapled anastomosis was performed on 276 patients (262 resections and 14 bypasses). Following resection, there were 11 (5 per cent) anastomotic leaks in the hand-sewn group and ten (3.8 per cent) in the stapled anastomosis group (P = 0.69). Excluding anastomotic leaks, hospital mortality and anastomotic recurrence, stricture occurred in 18 of 172 hand-sewn anastomoses (10.5 per cent) and in 57 of 195 stapled anastomoses (29.2 per cent) (P less than 0.001). In patients who had bypass operations there were 12 anastomotic leaks, ten in the hand-sewn group (12.0 per cent) and two in the stapled anastomosis group (14.3 per cent). Only two of the discharged patients with bypass developed anastomotic strictures, a low incidence probably because of short survival. In addition, there were 245 subsidiary anastomoses made in the abdomen by the hand-sewn method as part of the reconstructive procedure, and there was one leak. The results of this non-randomized study suggest that hand-sewn anastomosis using a single layer continuous technique for the oesophagus is as safe as the use of circular staplers; hand-sewn anastomosis is less likely to become stenotic.

A personal perspective on controversies in the surgical management of oesophageal cancer

“…A non-randomised comparison of 580 anastomoses and a subsequent large RCT showed that there was no significant difference in leak rate between sutured and stapled anastomoses but that the stapled technique produced a much higher rate of stricture. 33,34 These findings have been supported by a meta-analysis 35 and numerous other studies. Stricture formation is also more common after cervical than after thoracic anastomosis, with strictures requiring dilation in 30-66% of cases.…”

“…The majority of the available evidence suggests intrathoracic location and hand sewn technique are both predictors of a low rate of anastomotic stricture. [3][4][5][33][34][35] It seems difficult to justify the use of stapling devices to fashion anastomoses after oesophageal resection. A hand sewn anastomosis is cheap.…”

Anastomotic Complications after Esophagectomy

“…There was no difference as only 1 patient in the first group developed a clinically asymptomatic leak. Fok et al [24]compared a single-layer continuous hand-sewn anastomosis with circular stapling in a prospective nonrandomized study including 580 patients. There were 5% anastomotic leaks in the hand-sewn group and 3.8% in the stapled anastomosis group (p = 0.69).…”

Single-layer continuous suture contributes to the reduction of surgical complications in digestive tract anastomosis involving special anatomical locations

“…Single-layer continuous suture is a method commonly used for vessel anastomosis in deep locations. The tightness and safety of the single-layer suture has been proven in anastomoses of the digestive tract (23,24). However, the combination of single-layer and continuous suturing in anastomosis is rarely reported.…”