Esophagogastric anastomosis with invagination into stomach: New technique to reduce fistula formation

Henriques, Alexandre Cruz

doi:10.3748/wjg.v16.i45.5722

Cited by 6 publications

(5 citation statements)

References 28 publications

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“…The results of the current study demonstrated that the incidence rate of total complications was 50%, and anastomosis complication was 13.3%. The results were higher than those identified in the previously described studies, but lower than a study which reported postoperative minor complications in 70.9% of patients and serious complications in 22.6% of patients following esophagogastric anastomosis ( 30 ). The reasons of complication in the present study may have also involved the following: i) Preoperative preparation, due to the challenges of bowel preparation and implantation of the gastric pipe; and ii) insufficient nutrition supply for animals following surgery.…”

Section: Discussioncontrasting

confidence: 77%

Efficacy of single-layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract

Zhang

et al. 2014

Oncology Letters

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Surgery for digestive tract disease predominantly consists of reconstruction and anastomosis. Due to the difficult location, anastomosis is extremely challenging and the risk of complication increases accordingly. Traditional manual anastomosis and the application of a stapling device are insufficient. Therefore, the aim of this study was to investigate the feasibility and safety of a novel manual method in a difficult anastomotic location, consisting of a single-layer continuous suture in the posterior wall. In total, 15 beagle dogs were included in the study; eight underwent surgery with the novel manual method for reconstruction and anastomosis of the digestive tract, while seven underwent surgery with the stapler device as a control. The subsequent postoperative complications were observed and, three months later, the anastomotic ports were excised, and the pathological formation and morphological changes were evaluated. No statistically significant differences were identified between the total (50.0 vs. 57.1%; P=0.782) and anastomotic (0.0 vs. 28.6%; P=0.200) complication rates in the manual suture and staple suture groups, respectively. Compared with the control group, the operative expenditure was lower in the manual group (1726.7±33.5 vs. 2135.7±43.1 renminbi; P=0.001), the diameter of the anastomotic port was larger in the manual group (3.04±0.07 vs. 2.24±0.25 cm; P=0.004) and the thickness of the anastomotic port (in cm) was thinner in the manual group (2.94±0.06 vs. 5.07±0.85; P=0.002). Furthermore, the pathological formation of the anastomositic port in the manual group was improved. The results of the current study suggest single-layer continuous suture of the posterior wall in anastomosis of the digestive tract to be a novel method with feasibility and safety, particularly in difficult anastomotic locations.

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Section: Discussioncontrasting

confidence: 77%

Efficacy of single-layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract

Zhang

et al. 2014

Oncology Letters

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“…We conducted a comparative study of the cervical esophagogastric anastomosis with and without invagination after esophagectomy for cancer and observed significantly lower incidence of fistula when the anastomosis was performed with invagination 18 and that the fistula had minimal clinical impact 18,19 .…”

Section: Introductionmentioning

confidence: 99%

“…These approaches include: anastomosis in two stages 11 , revascularization of the gastric tube 12 , laparoscopic mobilization of the stomach and preparation of the gastric conduit five days before the esophagectomy 13 , omentoplasty of cervical esophagogastrostomy 14,15 , stapled anastomosis following partial resection of the sternum and left clavicle 16 , manual two-layer anastomosis 1 , mucosal tube technique 17 and anastomosis with invagination [18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

Cervical esophagogastric anastomosis with invagination after esophagectomy

et al. 2012

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PURPOSE: To evaluate the incidence of fistula and stenosis of the cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach after subtotal esophagectomy. METHODS:We studied 54 patients who underwent subtotal esophagectomy, 45 (83.3%) patients with carcinoma and nine (16.6%) with advanced megaesophagus. In all cases the cervical esophagogastric anastomosis was performed with the invagination of the proximal esophageal stump inside the stomach. RESULTS:Three (5.5%) patients had a fistula at the esophagogastric anastomosis, two of whom with minimal leakage of air or saliva and with mild clinical repercussion; the third had a low output fistula that drained into the pleural space, and this patient developed empyema that showed good progress with drainage. Fibrotic stenosis of anastomosis occurred in thirteen (24%) subjects and was treated successfully with endoscopic dilatation. CONCLUSION:Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula and stenosis, thus becoming an attractive option for the reconstruction of alimentary transit after subtotal esophagectomy. Key words: Esophagus. Esophagectomy. Constriction, Pathologic. Anastomotic Leak, Gastroplasty. RESUMOOBJETIVO: Avaliar a incidência de fístula e estenose da anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago após esofagectomia subtotal. MÉTODOS:Foram estudados 54 pacientes submetidos à esofagectomia subtotal, 45 (83,3%) com carcinoma e nove (16,6%) com megaesôfago chagásico avançado. Em todos os casos, a anastomose esofagogástrica cervical foi realizada com invaginação do coto esofágico proximal no interior do estômago. RESULTADOS:Três (5,5%) pacientes apresentaram fístula, dois deles com saída mínima de ar e saliva pela incisão cervical que evoluíram com rápida cicatrização; o terceiro apresentou fístula de pequeno débito que drenou para o espaço pleural causando empiema que teve boa evolução após drenagem. Treze (24%) doentes apresentaram estenose fibrótica e foram tratados com sucesso com dilatação endoscópica. CONCLUSÃO:A anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago apresentou baixa incidência de fístula e estenose tornando-se opção atraente para a reconstrução do trânsito alimentar após esofagectomia subtotal.

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“…Fourth, salivary amylase of saliva is an influence factor for ENF healing. And there were some studies had shown that increased saliva level would prevent oral or esophageal fistulas from healing [ 21 – 23 ]. In future clinical applications and studies, the patient's nutritional supply will be strictly controlled, stratified analysis will be performed, and the protection of esophageal defects will be strengthened.…”

Section: Discussionmentioning

confidence: 99%

Vacuum sealing drainage combined with naso-intestinal and gastric decompression tubes for the treatment of esophagogastrostomy neck fistula

Tian

et al. 2022

J Cardiothorac Surg

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Objective To evaluate the clinical results of the vacuum sealing drainage (VSD) combined with a naso-intestinal nutritional tube (NIT) and a gastric decompression tube (GDT) for the treatment of esophagogastrostomy neck fistula (ENF). Methods From January 2018 to October 2020, twenty patients (13 men and 7 women, ages 46–72) with ENF secondary to esophagogastrostomy were treated with VSD combined with NIT and GDT. Technical and clinical success rates, the incidence of early/late complications, the time of fistula closure (TFC) and therapy-related indicators were analyzed. The Karnofsky score and Eastern Cooperative Oncology Group (ECOG) score were compared before and after triple treatment. Results Technical and clinical success rates were 100% and 85%, respectively. Early complications occurred in 5/20 (25%) patients, and late complications occurred in 8/20 (40%) patients. The median TFC was 18 days (range 10–23). All therapy-related indicators were normalized posttreatment. The Karnofsky score and ECOG score after treatment were significantly different compared with pretreatment scores (p < 0.001). Conclusion VSD combined with NIT and GDT is a safe and effective strategy for ENF, while severe strictures warrant further research.

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Esophagogastric anastomosis with invagination into stomach: New technique to reduce fistula formation

Abstract: Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula with mild clinical repercussions.

Cited by 6 publications

References 28 publications

Efficacy of single-layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract

Efficacy of single-layer continuous suture of the posterior wall in anastomosis involving a difficult location of the digestive tract

Cervical esophagogastric anastomosis with invagination after esophagectomy

Vacuum sealing drainage combined with naso-intestinal and gastric decompression tubes for the treatment of esophagogastrostomy neck fistula

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