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World Journal of Surgery

, Volume 37, Issue 5, pp 1043–1050 | Cite as

A Prospective Randomized Controlled Trial of Semi-mechanical versus Hand-sewn or Circular Stapled Esophagogastrostomy for Prevention of Anastomotic Stricture

  • Wen-Ping Wang
  • Qiang Gao
  • Kang-Ning Wang
  • Hui Shi
  • Long-Qi ChenEmail author
Article

Abstract

Background

Successful anastomosis is essential in esophagogastrectomy, and the application of the circular stapler effectively reduces the anastomotic leakage, although stricture formation has become more frequent. The present study, a randomized controlled trial, compared the recently developed semi-mechanical anastomosis with a hand-sewn or circular stapled esophagogastrostomy in prevention of anastomotic stricture.

Methods

Between November 2007 and September 2008, 160 consecutive patients with esophageal carcinoma underwent surgical treatment our department. Five patients were excluded from this study, and the remaining 155 patients were completely randomized to receive either an everted plus side extension esophagogastrostomy (semi-mechanical [SM] group) or a conventional hand-sewn esophagogastric anastomosis ([HS] group) or a circular stapled ([CS] group) esophagogastric anastomosis, after dissection of the esophageal tumor and construction of a tubular stomach. The primary outcome was the incidence of an anastomotic stricture at 3 months after the operation (defined as the diameter of the anastomotic orifice ≤0.8 cm on esophagogram). Secondary outcomes were the dysphagia score and reflux score, as well as the anastomotic diameter.

Results

The anastomotic stricture rate was 0 % (0/45) in the SM group, 9.6 % (5/52) in the HS group, and 19.1 % (9/47) in the CS group (p < 0.001). The mean diameter of the anastomotic orifice was 18.2 ± 4.7 mm in the SM group, 11.5 ± 2.4 mm in the HS group, and 9.5 ± 3.0 mm in the CS group (p < 0.001). The reflux/regurgitation score among the three groups was similar.

Conclusions

Semi-mechanical esophagogastric anastomosis could prevent stricture formation more effectively than hand-sewn or circular stapler esophagogastrostomy, without increasing gastroesophageal reflux.

Keywords

Anastomotic Stricture Circular Staple Stricture Formation Stricture Rate Esophagogastric Anastomosis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Société Internationale de Chirurgie 2013

Authors and Affiliations

  • Wen-Ping Wang
    • 1
  • Qiang Gao
    • 1
  • Kang-Ning Wang
    • 1
  • Hui Shi
    • 1
  • Long-Qi Chen
    • 1
    Email author
  1. 1.Department of Thoracic SurgeryWest China Hospital, Sichuan UniversityChengduPeople’s Republic of China

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