Experience and outcomes of mechanical cervical esophagogastric anastomosis formation

• Ireyhan M. Tadzhibova
• Shestakov A.L.
• Vetshev F.P.
• Tskhovrebov A.T.
• Tarasova I.A.
• Petrosyan T.V.
• Bezaltynnykh A.A.

Abstract

Background. Formation of a successful esophagogastro- or esophagocoloanastomosis is the key moment in the reconstruction of the upper gastrointestinal tract after esophagectomy. Numerous studies indicate the need to continue evaluating and searching for optimal methods to form esophageal anastomoses.

Aim - to compare outcomes of surgery with cervical mechanical and hand-sewn esophagogastric anastomosis formation.

Material and methods. 50 patients after esophagectomy with stapled (1^st group, n=23) and hand-sewn esophagogastroanastomoses (2^nd group, n=27) formation between January 2014 and March 2020 were included in this study of Department of Thoracoabdominal Surgery and Oncology at Petrovsky National Research Centre of Surgery. We evaluated and compared incidence of postoperative complications, duration of operations and anastomosis time in both groups. 

Results. The mean operating time and anastomosis time was shorter when the stapled method was used (451 vs 491 min, 20 vs 65 min; p<0.005). Totally, 7 cases of esophageal anastomotic leakage were noted, 1 (4.3%) in the 1^st group and 6 (22.2%) in the 2^nd group. In the only patient of the 1^st group the postoperative period was also complicated by the fistula formation between the membranous part of the trachea and the gastric tube with the development of a graft stricture, which required esophagoplasty with colonic interposition. In the study of long-term outcomes anastomotic stricture was detected in 5 patients of the 2^nd group, of which 1 (5%) underwent retrosternal esophageal bypass using a mid-colon esophagocoloplasty for persistent stricture of esophagogastroanastomosis. In other cases, anastomotic stricture was eliminated by endoscopic bougination procedures. The severity of other Clavien-Dindo complications in both groups did not exceed Grade I.

Conclusion. Formation of mechanical esophageal anastomoses allows to reduce the incidence of postoperative complications, therefore, improve patient's quality of life.

Keywords:esophagoplasty, anastomotic leakage, anastomotic stricture, stapled esophagogastro-anastomosis

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