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iTriangular Stapling Technique: A Novel Reconstruction Method and Clinical Outcomes of Cervical Esophagogastric Anastomosis after Esophagectomy

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Abstract

Background

We herein report the feasibility and safety of cervical end-to-end anastomosis by the iTriangular stapling technique (iTST), which was developed as an extension of the triangular stapling technique (TST) after minimally invasive esophagectomy (MIE).

Methods

A total of 45 patients with thoracic esophageal cancer who underwent reconstruction with cervical esophagogastric anastomosis by iTST using a linear stapler after MIE between January 2016 and January 2019 were retrospectively reviewed. We modified and improved upon the TST by adding a 1- to 2-cm vertical incision on the anterior wall of the remnant esophageal stump to enlarge the anastomotic lumen and thereby reduce the risk of anastomotic stenosis. The short-term patient outcomes were determined to assess the safety and feasibility of our procedures.

Results

The median operating time was 686 (range, 319–1110) minutes, and the median blood loss was 170 (range, 5–1180) ml. There were no cases of anastomotic stenosis in this study, although 2 patients (4.4%) developed minor anastomotic leakage. A case (2.2%) of tracheal fistula due to the apex of the triangular anastomosis was resolved simply by delaying the patient’s oral intake. The mean length of the hospitalization was 21 days.

Conclusions

The iTST provides a larger lumen unlimited by the size of the esophagus in cervical esophagogastric anastomosis. This technique is feasible, and sufficient short-term results have been achieved. Further studies with the accumulation of more cases will be required to prove the benefits of iTST for reconstruction after MIE.

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Authors and Affiliations

  1. Department of Surgery I, School of Medicine, University of Occupational and Environmental Health Japan, Kitakyushu, Japan

    Kazunori Shibao, Yuzuru Inoue, Yusuke Sawatsubashi, Siro Kohi, Nobutaka Matayoshi, Takayuki Tanoue, Nagahiro Sato, Takefumi Katsuki & Keiji Hirata

Authors
  1. Kazunori Shibao
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  2. Yuzuru Inoue
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  3. Yusuke Sawatsubashi
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  4. Siro Kohi
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  5. Nobutaka Matayoshi
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  6. Takayuki Tanoue
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  7. Nagahiro Sato
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  8. Takefumi Katsuki
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  9. Keiji Hirata
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Correspondence to Kazunori Shibao.

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Conflict of interest

The authors declare that they have no conflict of interest or financial ties to disclose. All procedures were conducted in accordance with the ethical standards of the respective committees on human experimentation (institutional and national) and with the 1964 Declaration of Helsinki and later versions. This study was approved by the Ethics Committee of University of Occupational and Environmental Health, Kitakyushu, Japan.

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Shibao, K., Inoue, Y., Sawatsubashi, Y. et al. iTriangular Stapling Technique: A Novel Reconstruction Method and Clinical Outcomes of Cervical Esophagogastric Anastomosis after Esophagectomy. World J Surg 45, 1828–1834 (2021). https://doi.org/10.1007/s00268-021-05997-6

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  • DOI: https://doi.org/10.1007/s00268-021-05997-6

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