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Stapled Esophagogastric Anastomosis: An Effective and Reproducible Technique as Compared to a Hand-sewn Method
*Jia J Ding, *John C Wain, *Douglas J Mathisen, *Cameron D Wright, *Henning A Gaissert, *Dean M Donahue, *Michael Lanuti, James S Allan, *Ashok Muniappan, Christopher R Morse
Massachusetts General Hospital, Boston, MA

Objective: Esophagectomy anastomotic complications can lead to severe morbidity and mortality. We compare our experience with a stapled esophagogastric anastomosis to demonstrate safety and efficacy as compared to a hand-sewn technique. Design: Retrospective case series of 525 esophagectomies over a 10 year period (2001-2011) Setting: Dedicated thoracic surgery unit at tertiary care hospital Patients: 421 patients undergoing esophagectomy between 2001 and 2011 with either a handsewn or stapled anastomotic technique Main Outcome Measured: Demographics, Anastomotic technique, Type of esophagectomy, Tumor type, Anastomotic leak, Anastomotic stricture requiring dilation Results: Median age was 63 (28-91) with 80 % males (421). Approaches included Ivor Lewis, thoracoabdominal, transhiatal and a minimally invasive esophagectomies. Adenocarcinoma was present in 73% (385) of patients, squamous cell cancer in 12% (61), and a variety of other pathologic processes in 15%. Mean operative time employing a hand sewn technique was 7:09 (range, 3:12-11:24), for stapled procedures 6:09 (range, 4:20-8:40). 44% (230) of patients received preoperative, neoadjuvant therapy. A two layer, hand sewn technique was employed in 83% (434) patients and 17% (93) underwent a stapled anastomosis using an EEA stapler. 71% (65) of stapled anastomosis were performed with a 28mm EEA. There were no anastomotic leaks in the stapled group and 5.5% leak rate with a hand sewn technique (24 patients). 13% (12) of stapled anastomoses required dilation while 30% (133) required dilation in the hand-sewn group. Conclusions: We demonstrate a stapled approach is as reliable as hand-sewn when the same exacting standards are employed. The goal of every anastomotic technique should be zero anastomotic leaks and an adequate lumen. A stapled anastomosis, performed correctly, meets these criteria as compared to a hand-sewn technique.

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May 5, 2014

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August 13, 2014

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August 11, 2014
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