ANASTOMOSIS

Esophageal anastomosis is still associated with a high rate of complic ations even though they have decreased considerably in recent years. A nastomotic leaks are more frequent in the neck than in the chest, and related mortality rate is not different. The leakage incidence does no t depend on suture materials or on technical modalities used to perfor m the anastomosis. In fact, there is no difference between the leakage rate when comparing manual and mechanical anastomoses. The leak incid ence after both mechanical and manual anastomoses is much higher in co llective reviews than in reports coming from leading centers. ''Freque nt'' esophageal surgeons can learn from their previous experience and therefore avoid technical errors, whereas ''casual'' esophageal surgeo ns do not have this opportunity. Performing an esophageal anastomosis is a technical matter, and suture healing is independent of the patien t's biologic situation. Anastomotic fibrotic strictures are frequent a fter both manual and mechanical anastomoses, and most can be avoided b y meticulous suturing technique.