Double-stapled esophagogastric anastomosis for resection of esophagogastric or cardia cancer: New application for an old technique

In colorectal surgery, the double-stapled technique is used extensively, be cause it is a fairly safe and simple procedure and is useful in relatively inaccessible areas. For these reasons, we adapted the procedure to the uppe r gastrointestinal tract. The present study reports our first experiences o f the surgical efficacy using an esophagogastric double-stapled end-to-end anastomosis for subtotal esophagectomy and cardia resection. We retrospecti vely studied 31 patients treated between January 1991 and January 1997 with respect to hospital mortality, anastomotic leakage, cancer recurrence, and benign stricture rate. No hospital mortality was seen. One nonfatal anasto motic leak occurred (3%). In three patients, esophageal resection was not r adical (10%). Of the remaining 28 patients, one had an anastomotic cancer r ecurrence (4%). Eleven of the remaining 27 patients (41%) developed a benig n anastomotic stricture. All achieved normal swallowing after a median of t wo endoscopic dilatation procedures using TTS balloons. In conclusion, the double-stapled end-to-end anastomosis technique after resection for esophag ogastric or cardia cancer is a simple and expeditious procedure, carrying a n acceptable perioperative morbidity and cancer recurrence rate. Larger sta plers are recommended to lower the high stricture rate observed after the u sage of a 21-mm stapler in this study.