Hand-sewn versus stapler esophagogastric anastomosis after esophageal ressection: sistematic review and meta-analysis

Castro, Paula Marcela Vilela; Ribeiro, Felipe Piccarone Gonçalves; Rocha, Amanda de Freitas; Mazzurana, Mônica; Alvarez, Guines Antunes

doi:10.1590/s0102-67202014000300014

Cited by 18 publications

(10 citation statements)

References 19 publications

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“…In contrast, the minimally invasive hand-sewn anastomosis takes the form of an adaptation of thoracotomic handsewn anastomosis, which is preferred by many surgeons as it seems to be associated with the lowest rate of anastomotic leaks [20]. For this reason, the hand-sewn anastomosis was translated in minimally invasive field.…”

Section: Discussionmentioning

confidence: 99%

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

et al. 2021

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Background Minimally invasive Ivor Lewis esophagectomy (MIILE) provides better outcomes than open techniques, particularly in terms of post-operative recovery and pulmonary complications. However, in addition to requiring advanced technical skills, thoracoscopic access makes it hard to perform esophagogastric anastomosis safely, and the reported rates of anastomotic leak vary from 5 to 16%. Several minimally invasive esophago-gastric anastomotic techniques have been described, but to date strong evidence to support one technique over the others is still lacking. We herein report the technical details and preliminary results of a new robot-assisted hand-sewn esophago-gastric anastomosis technique. Methods From January 2018 to December 2020, 12 cases of laparoscopic/thoracoscopic Ivor Lewis esophagectomy with robot-assisted hand-sewn esophago-gastric anastomosis were performed. The gastric conduit was prepared and tailored taking care of vascularization with a complete resection of the gastric fundus. The anastomosis consisted of a robot-assisted, hand-sewn four layers of absorbable monofilament running barbed suture (V-lock). The posterior outer layer incorporated the gastric and esophageal staple lines. Results The post-operative course was uneventful in nine cases. Two patients developed chyloperitoneum, one patient a Sars-Cov-2 infection, and one patient a late anastomotic stricture. In all cases, there were no anastomotic leaks or delayed gastric conduit emptying. The median post-operative stay was 13 days (min 7, max 37 days); the longest in-hospital stay was recorded in patients who developed chyloperitoneum. Conclusion Despite the small series, we believe that our technique looks to be promising, safe, and reproducible. Some key points may be useful to guarantee a low complications rate after MIILE, particularly regarding anastomotic leaks and delayed emptying: the resection of the gastric fundus, the use of robot assistance, the incorporation of the staple lines in the posterior aspect of the anastomosis, and the use of barbed suture. Further cases are needed to validate the preliminary, but very encouraging, results.

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Section: Discussionmentioning

confidence: 99%

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

et al. 2021

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“…Circular staplers are reported to have higher stricture rates when compared with linear stapling. 24,25 However, even well-perfused, well-constructed anastomoses without any tension along the anastomotic line can develop an AL or AS. Despite the belief of surgeons in their own surgical techniques and predictive capabilities, clinical studies demonstrate that surgeons cannot predict with absolute accuracy which anastomoses will develop leak or stricture and which will not.…”

Section: Discussionmentioning

confidence: 99%

Role of Covering Ileostomy in Causation of Anastomotic Strictures in Low Anterior Resections for Rectum Carcinoma

Khan¹,

Wani

Mehraj

et al. 2021

Journal of Coloproctology

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Background Colorectal resection anastomosis is the commonest cause of rectal strictures. Anastomotic site ischemia, incomplete doughnuts from stapled anastomosis and pelvic infection, are some of the risk factors that play a role in the development of postoperative rectal strictures. However, the role of diverting stoma in the development of rectal strictures has not been studied extensively. Objectives To study the difference in the occurrence of anastomotic strictures (AS) in patients submitted to low anterior resection (LAR) with covering ileostomy (CI), and to LAR without CI for carcinoma rectum. Methods This was a prospective, comparative case control study carried out at a tertiary care referral center. Low anterior resection with covering ileostomy was performed in patients with rectum carcinoma in the study group, while LAR without covering ileostomy was performed in the control group. The study group had 29 patients, while the control group had 33 patients with rectum carcinoma. Results During the mean follow-up period of 9.1months, 8 (28%) patients in the study group and 2 (6%) patients in the control group developed AS (p =0.019). Out of these 8 patients with AS in the study group, 50% had Grade-I AS, 25% had Grade-II AS, while 25% of the patients had Grade-III (severe) AS. However, both patients who developed AS in the control group had a mild type (Grade I) of AS. Conclusion Covering ileostomy increases the chances of AS formation after LAR for rectum carcinoma. Also, the SKIMS Clinical Grading of Rectal Strictures is a simple and handy tool available for every surgeon to grade, classify and monitor the postoperative rectal strictures.

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“…Level 1a evidence indicates that stapling and hand-sewn anastomoses give equal results with regard to clinical anastomotic leakage, although hand-sewn anastomoses tend towards longer operation times [81][82][83][84][85][86][87][88][89][90][91]. For compression anastomoses there is a variety of devices and methods.…”

Section: Suture Techniquesmentioning

confidence: 99%

Innovative approaches for induction of gastrointestinal anastomotic healing: an update on experimental and clinical aspects

Reischl

Wilhelm

Frieß

2020

Langenbecks Arch Surg

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Purpose In most cases, traditional techniques to perform an anastomosis following gastrointestinal resections lead to successful healing. However, despite focused research in the field, in certain high-risk situations leakage rates remain almost unchanged. Here, additional techniques may help the surgeon to protect the anastomosis and prevent leakage. We give an overview of some of the latest developments on experimental and clinical techniques for induction of anastomotic healing. Methods We performed a review of the current literature on approaches to improve anastomotic healing. Results Many promising approaches with a high clinical potential are in the developmental pipeline. Highly experimental approaches like inhibition of matrix metalloproteinases, stem cell therapy, hyperbaric oxygen therapy, induction of the hypoxic adaptive response, and the administration of growth factors are still in the preclinical phase. Other more clinical developments aim to strengthen the anastomotic suture line mechanically while shielding it from the influence of the microbiome. Among them are gluing, seaming the staple line, attachment of laminar biomaterials, and temporary intraluminal tubes. In addition, individualized bowel preparation, selectively reducing certain detrimental microbial populations could become the next stage of bowel preparation. Compression anastomoses are evolving as an equivalent technique additional to established hand-sewn and stapled anastomoses. Fluorescence angiography and flexible endoscopy could complement intraoperative quality control additionally to the air leak tests. Virtual ileostomy is a concept to prepare the bowel for the easy formation of a stoma in case of leakage. Conclusion A variety of promising diagnostic and prophylactic measures that may support the surgeon in identifying high-risk anastomoses and support them according to their potential deficits is currently in development.

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Hand-sewn versus stapler esophagogastric anastomosis after esophageal ressection: sistematic review and meta-analysis

Cited by 18 publications

References 19 publications

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

Role of Covering Ileostomy in Causation of Anastomotic Strictures in Low Anterior Resections for Rectum Carcinoma

Innovative approaches for induction of gastrointestinal anastomotic healing: an update on experimental and clinical aspects

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