Experience and technique of stapled mechanical cervical esophagogastric anastomosis

Background. Anastomotic leak from cervical esophagogastric anastomoses is a serious problem after esophagectomy. We explored the efficacy of partial o r total mechanical anastomoses accomplished with the endoscopic linear cutt ing and stapling device as an alternative to hand-sewn anastomotic techniqu es. Methods. During a 42-month period, 93 patients undergoing either transhiata l esophagectomy or a three-incisional approach to esophagectomy underwent e ither hand-sewn (n = 43), partial mechanical (n = 16), or totally mechanica l (n = 34) cervical esophagogastric anastomoses. The occurrence of postoper ative anastomotic leak and the development of postoperative anastomotic str icturing requiring dilation therapy were analyzed between these groups usin g chi (2). Results. All patients survived esophagectomy and were available for postope rative follow-up. Anastomotic leak developed in 10 patients (23%) with hand -sewn, 1 patient (6%) with partial mechanical, and 1 patient (3%) with tota l mechanical anastomoses (p < 0.05). Anastomotic stricture development para lleled the occurrence of anastomotic leak rate with 25 patients (58%) with hand-sewn, 3 patients (19%) with partial mechanical, and 6 patients (18%) w ith total mechanical anastomoses experiencing strictures requiring dilation therapy (p < 0.05). Conclusions. These results suggest that partial or mechanical cervical esop hagogastric anastomoses created with the endoscopic stapling device may be superior to hand-sewn anastomotic techniques. (C) 2001 by The Society of Th oracic Surgeons.