TERMINALIZED SEMIMECHANICAL SIDE-TO-SIDE SUTURE TECHNIQUE FOR CERVICAL ESOPHAGOGASTROSTOMY

Background. The classic manual end-to-side technique of esophagogastro stomy after gastric pull-up to the neck carries a rather high risk of fistula and stricture. Methods. A terminalized semimechanical side-to- side technique of cervical esophagogastrostomy was performed in 16 pat ients by the application of an Endo-GPA stapler across the gastric and esophageal walls placed side by side, so as to create a V-shaped post erior opening between the two lumina. The anterior aspect of the anast omosis was hand-sewn using a classic running suture. The cross-section al area of the semimechanical anastomoses was estimated by barium swal low study 2 months after operation and compared with that of 24 manual end-to-side esophagogastrostomies. Results. The cross-sectional area was 225 +/- 15.7 mm(2) (mean a standard error of the mean) or the 16 s emimechanical anastomoses versus 136 +/- 15 mm(2) for the 24 manual an astomoses (p = 0.0001). The anastomotic area decreased from 206.6 +/- 13.5 mm(2) in 29 patients without dysphagia to 107.5 +/- 4.7 mm(2) in 7 patients with moderate dysphagia for solids that did not require end oscopic dilation and to 55.7 +/- 16 mm(2) in 4 patients with severe dy sphagia that required dilation (p = 0). The anastomotic area in 6 of t he 7 patients with initial moderate dysphagia for solids increased spo ntaneously with time from 107.3 +/- 5.5 mm(2) to 174.6 +/- 8.1 mm(2), with concomitant symptomatic relief (p = 0.0277). Conclusions. The ter minalized semimechanical side-to-side suture technique produces a larg er anastomosis than the classic end-to-side esophagogastrostomy techni que. inflammatory changes related to the operation may cause transient narrowing of a cervical esophagogastrostomy. (C) 1998 by The Society of Thoracic Surgeons.