A free peritoneal patch does not affect the leakage rate but increases stricture formation of a cervical esophagogastrostomy

Background: Healing of a cervical esophagogastrostomy is frequently impaire d, resulting in a higher incidence of leakage and stricture formation, as c ompared to an intrathoracic anastomosis. Lack of mesothelial factors is hyp othesized to contribute to this impaired anastomotic healing. The aim of th is prospective study was to determine whether a free peritoneal patch aroun d a cervical esophagogastrostomy can improve anastomotic healing. Methods: In 23 consecutive patients a free peritoneal patch was fixed around a cervi cal esophagogastrostomy, Results were compared to those of a historical con trol group of 41 patients, Clinical and/or radiographic leakage and stenosi s requiring endoscopic dilatation were used as endpoints. Results: Three pa tients died in the early postoperative period (in-hospital mortality 3/64 = 5%). Leakage rate was 13% (3/23) in the group with a patch and 15% (6/41) in the control group (p = 0.90). At 6-month follow-up, the incidence of ste nosis was significantly higher (65%) in the group with a patch, compared to 31% in the control group (p = 0.02). Conclusion: A peritoneal patch does n ot affect the leakage rate ut increases the incidence of postoperative sten osis of a cervical esophagogastrostomy, Therefore, its clinical application is contraindicated. Copyright (C) 1999 S. Karger AG, Basel.