ESOPHAGOGASTRECTOMY WITH AN ANASTOMOSIS USING LINEAR STAPLERS

Background: Fibrous stricture formation causing dysphagia after oesoph agogastrectomy with a circular stapled or sutured anastomosis remains a significant complication, occurring in up to one-third of cases. An anastomosis that avoids this complication would be desirable, given th at resection is often performed to palliate dysphagia. We describe a t echnique of oesophagogastric anastomosis using linear staplers which e liminates the postoperative complication of fibrous stricture formatio n. Method: A retrospective analysis of 111 consecutive patients who un derwent oesophagogastrectomy for neoplasm or benign oesophageal strict ure between March 1980 and April 1991 was carried out. Cadaveric model s of the anastomosis were constructed and compared to models of circul ar stapled anastomoses. Results: An anastomosis using linear staplers was used in 111 patients with a leak rate of 2.7%, 30-day and hospital mortality rates of 5.4% and 8.1%, respectively, and no benign strictu re formation. In the cadaveric models, the cross-sectional areas of th e linear stapled anastomoses were greater than those of the circular s tapled anastomoses, suggesting that this is an important factor in pre venting fibrous stricture formation. Conclusions: An anastomosis using linear staplers can be performed with a low leak rate, an acceptable operative mortality and no benign stricture formation. We suggest that an anastomosis using linear staplers should be the preferred type of anastomosis in oesophagogastrectomy.