Pre‐embedded cervical circular stapled anastomosis in esophagectomy

Abstract

Background Mechanical anastomosis is now widely used in surgery for esophageal cancer. An anastomotic fistula is still the most dangerous complication in mechanical anastomosis, especially for patients who undergo cervical anastomosis. However, due to the high anastomosis position and limited space, conventional embedding and suspension are rarely performed. This study aimed to introduce the steps of an improved embedded method in cervical circular stapled anastomosis and evaluate its efficacy in reducing complications. Methods In total, 31 patients who underwent minimally invasive esophagectomy were enrolled into the study. Pre‐embedded cervical esophagogastrostomy with a circular stapler was adopted after thoracoscopic and laparoscopic esophagectomy for esophageal cancer. Results The results of surgical duration, blood loss, mean duration of hospitalization and operation complications such as anastomotic fistula, anastomotic stenosis and gastroesophageal reflux were recorded. The operative procedure lasted between 205–300 minutes with an average of 260.3 minutes. The postoperative recovery was good, with no complications such as anastomotic fistula, anastomotic stricture and pulmonary complication, except for two cases of gastroesophageal reflux. The postoperative hospital stay was 8–14 days with an average of 10.3 days. Conclusion Our data revealed that pre‐embedded cervical circular stapled anastomosis is an alternative for patients with good stomach length, which can decrease the occurrence rate of anastomotic fistula by full peripheral embedding of anastomotic stoma. Key points This new technique can significantly reduce the risk of anastomotic leakage. This study adds further details enabling a smooth pre‐embedded procedure to be performed.

Risk Factors of Benign Stricture of Anastomotic Stoma after Esophagectomy and Therapeutic Effect of Stent Implantation

“…Esophageal cancer is a high-incidence disease in the country. Currently, esophageal cancer is mainly treated by surgery, and although the effect is significant, complications such as postoperative anastomotic stenosis have always been a clinical problem [ 11 ]. Through investigation, it was found that 4 weeks after operation was a period of high incidence of anastomotic stenosis, 15% of patients were found to have anastomotic stenosis by endoscopy, and 42% of patients had swallowing function [ 12 ].…”

Circular vs. linear stapling after minimally invasive and robotic-assisted esophagectomy: a pooled analysis

“…While MIE is not yet seen as a standard procedure but becoming increasingly popular, mechanical anastomosis is already performed routinely in esophagectomy [ 6 ]. Mechanical anastomoses can be performed using linear stapling (LS) and circular stapling (CS) devices.…”

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

“…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.…”

“…Although efficacy of mechanical anastomosis had been reported previously ( 12 , 16 , 17 ), much effort had still been tried to better off the clinical outcome and simplify the procedure ( 18 , 19 ). Chen et al ( 20 ) reported that use of pleural flaps in the upper mediastinum would reduce the incidence of cervical subcutaneous emphysema and anastomotic leakage into pleural cavity.…”