The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy

Hosoi, Takahiro; T, Abe; Uemura, Naomi; Higaki, Eiji; Kawai, Ryosuke; Kawakami, Jiro; An, Byonggu; Nagino, Masato; Shimizu, Yasuhiro

doi:10.1007/s00268-019-04938-8

Cited by 17 publications

(18 citation statements)

References 43 publications

(57 reference statements)

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“…The anastomotic lumen is dependent on the original esophageal diameter, which leads to a high prevalence of anastomotic stricture. Treatment of anastomotic stricture often requires repeated dilations, 5 which adversely affect postoperative recovery and QOL for several months both physically and emotionally. In fact, several domains (dysphagia, choking when swallowing, and emotional functioning) at 3 months after surgery were significantly better for patients in the MC than CS group.…”

Section: Discussionmentioning

confidence: 99%

“…When the esophageal diameter was ≥30 mm, we used a 29-mm circular stapler (ILS; Ethicon, Tokyo, Japan). When the esophageal diameter was <30 mm, we used a 25-mm circular stapler (ILS; Ethicon, Tokyo, Japan) to avoid damaging the esophageal walls upon insertion of the anvil 5 . The body of the circular stapler was inserted through the gastrotomy at the top of the gastric conduit, and the anastomosis was created at the greater wall of the gastric conduit.…”

Section: Methodsmentioning

confidence: 99%

“…When the esophageal diameter was <30 mm, we used a 25-mm circular stapler (ILS; Ethicon, Tokyo, Japan) to avoid damaging the esophageal walls upon insertion of the anvil. 5 The body of the circular stapler was inserted through the gastrotomy at the top of the gastric conduit, and the anastomosis was created at the greater wall of the gastric conduit. After completion of the anastomosis, the distal end of the gastric conduit was excised at about 2 cm from the anastomosis using a 3row linear stapler.…”

Section: Cs Techniquementioning

confidence: 99%

“…Notably, however, the prevalence of cervical anastomotic stricture using the CS technique reportedly ranges from 17% to 48%. [1][2][3][4][5] This high prevalence of anastomotic stricture is a serious disadvantage that adversely affects patients' postoperative recovery, nutritional status, and quality of life (QOL).…”

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confidence: 99%

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Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy

Hosoi

T²,

Higaki³

et al. 2021

Annals of Surgery

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Objective: This study was performed to investigate the efficacy of the modified Collard (MC) technique for reducing anastomotic stricture after esophagectomy compared with the circular stapled (CS) technique. Summary Background Data: The currently available techniques of anastomosis after esophagectomy are associated with a significant risk of anastomotic complications. However, the optimal anastomotic technique after esophagectomy has not yet been established. Methods: We randomly allocated patients to either the CS group or the MC group. The primary endpoint was the incidence of anastomotic stricture. The secondary endpoints included the incidence of postoperative complications (including anastomotic leakage) and quality of life (QoL). All anastomoses were performed after indocyanine green evaluation for objective homogenization of blood flow to the gastric conduit between the 2 techniques. Results: Among 100 randomized patients (CS group, n ¼ 50; MC group, n ¼ 50), anastomotic strictures were observed in 18 (42%) patients in the CS group and in no patients in the MC group. There were no significant between-group differences in anastomotic leakage (CS group, 7% vs MC group, 8%; P ¼ 0.94). Quality of life domains of dysphagia and choking when swallowing at 3 months after surgery were significantly better in the MC group than in the CS group. Conclusions: The MC technique reduces the incidence of anastomotic stricture and improves postoperative quality of life. Furthermore, the incidence of anastomotic leakage is comparable between the 2 techniques based on accurate comparison under objective homogenization of the gastric conduit condition.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Cs Techniquementioning

confidence: 99%

mentioning

confidence: 99%

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Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy

Hosoi

T²,

Higaki³

et al. 2021

Annals of Surgery

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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%

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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The impact of circular stapler size on the risk of anastomotic stricture following total mesorectal excision in rectal cancer patients: A retrospective cross‐sectional study

Behboudi,

Ahmadi‐Tafti,

Hosseini

et al. 2023

Health Science Reports

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IntroductionColorectal cancer (CRC) surgery complications are a major issue affecting morbidity and mortality rates. Anastomotic stricture, which occurs in almost 30% of patients after surgery for rectal cancer, is one of the most serious but underreported side effects. In this study, we tried to assess the effect of stapler size on anastomotic stricture rate.Materials and MethodsAt our facility, all patients underwent low anterior resections (LAR) performed using an open laparotomy technique. A contour‐curved stapler and an end‐to‐end anastomosis (EEA) circular stapler were used in the double stapling technique (DST). All patients also underwent a protective loop ileostomy. Patients who developed stricture following leakage were excluded.ResultsThis study comprised a total of 173 rectal cancer patients. A 29‐mm circle stapler was used to anastomose 77 patients (44.5%), while a 31‐mm circular stapler was used to anastomose 96 patients (55.5%). Six individuals experienced strictures; two had a 29 mm stamper and four (4.4%) had a 31 mm one. There was no significant difference between the two groups (p:0.575). On aggregate, 8 patients experienced leakage; 3 (3.8%) of these patients received treatment with a 29 mm stapler, whereas 5 (5.2%) received treatment with a 31 mm stapler.Conclusionthis study found no statistically significant difference in the stricture rates and stapler size. The findings of this study provide credibility to the notion that in rectal cancer patients having LAR, strictures can be safely avoided by performing the anastomoses with both staplers.

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The Impact of Circular Stapler Size on the Incidence of Cervical Anastomotic Stricture After Esophagectomy

Cited by 17 publications

References 43 publications

Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy

Circular Stapled Technique Versus Modified Collard Technique for Cervical Esophagogastric Anastomosis After Esophagectomy

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

The impact of circular stapler size on the risk of anastomotic stricture following total mesorectal excision in rectal cancer patients: A retrospective cross‐sectional study

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