Minimizing cervical esophageal anastomotic complications by a modified technique

Background: The anastomotic leak and stricture formation after esophagectom y and cervical esophagogastric anastomosis deny patients with esophageal ca rcinoma the benefits of surgery. The present study was designed to ascertai n whether a wide cross-sectional area at the site of anastomosis leads to l esser anastomotic complications. Methods: One hundred patients with resectable carcinoma of the esophagus we re randomly distributed into two groups of 50 each. All patients underwent one-stage transhiatal esophagectomy. In group A, 3 X 2 cm gastric crescent was excised from the anterior wall of the gastric tube before constructing the cervical esophagogastric anastomosis. No such intervention was done in group B, which acted as control. All patients were followed up for at least 3 months for detection of anastomotic complications. Results: The incidence of anastomotic leak in the study group was significa ntly less in comparison with the control group (4.3% versus 20.8%; P = 0.03 ). Similarly. anastomotic stricture formation was significantly lower in th e study group (8.5% versus 29.2%; P = 0.02). Conclusions: A wide cross-sectional area achieved at the anastomotic site b y removal of gastric crescent resulted in significantly lower anastomotic c omplications. (C) 2001 Excerpta Medica. Inc. All rights reserved.