STAPLER DESIGN AND STRICTURES AT THE ESOPHAGOGASTRIC ANASTOMOSIS

An apparent reduction in the rate of benign anastomotic stricture afte r stapled esophagogastrectomy prompted us to review the results obtain ed with different stapling devices since 1988. We present a retrospect ive review of 125 consecutive patients undergoing esophageal resection for malignancy with stapled intrathoracic anastomoses. Benign anastom otic stricture was deemed present when a patient required endoscopic d ilatation to treat postoperative dysphagia. We found no difference in risk factors not related to stapler size (tumor histologic characteris tics, adjuvant therapy) between patients with stricture and patients w ithout stricture. Event-free survival was compared for different stapl er diameters as well as for different stapler designs. We found that s taplers of smaller diameter were associated with significantly more st rictures (p < 0.005). In a comparison of different designs of 25 mm st apler, the newer CDH device (Ethicon Ltd., Edinburgh, United Kingdom) was associated with a similar stricture rate to that associated with o ther designs (ILP [Ethicon] and EEA [Autosuture Company Division, Unit ed States Surgical Corp., Norwalk, Conn.]). For a given stapler diamet er, it appears that different stapler designs have no effect on strict ure rate.