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Completely Linear Stapled Versus Handsewn Cervical Esophagogastric Anastomosis After Esophagectomy

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Abstract

Very limited data is present which compares completely linear stapled to handsewn cervical esophagogastric anastomosis. Primary objective was to determine whether linearly stapled (LS) anastomosis has lower clinically apparent leaks, when compared to handsewn anastomosis (HS). Secondary objectives were morbidity, mortality, overall leak and stricture rates, and presence of a symptomatic cervical stricture. This is a comparative study of 77 patients who underwent LS (n = 29) and HS (n = 48) cervical anastomosis. Anastomotic leak was found to be 19.4% (15/77). In the HS group, 27.08% (13/48) and in the LS group, 6.89% (2/29), respectively, leaked (p = 0.03), relative risk (RR)—3.93 (95% CI 1.21–15.25). 32.5% (23/77) patients remained admitted for more than 14 days. 52.1% (25/48) patients in the HS group were discharged within 14 days of surgery; whereas; 93.1% (27/29) were discharged in LS group (p = 0.001), RR—6.95 (95% CI 2.13–25.94). Overall, 90-day mortality was 7.8% (6/77). In the HS group, 8.3% (4/48) patients died while in the LS group, 6.8% (2/29) patients died (p = 0.82), RR—1.21(95% CI 0.27–5.53). In the HS group, 6.25% (3/48) patients were diagnosed with stricture compared to 6.8% (2/29) patients in the LS group (p = 0.9), RR—0.91 (95% CI 0.19–4.44). Overall stricture rate was 6.4% (5/77). Cervical anastomosis done with linear staplers has less leak rates compared to handsewn anastomosis.

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Authors and Affiliations

  1. Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    Tarun Kumar, Jyoti Swain & Manoj Pandey

  2. Department of Surgical Oncology, JSS Medical College, Mysore Bangalore Road, Bannimantap, Mysuru, 570015, India

    Ravi Krishanappa, Raxith Sringeri & Sindhuri Kondapavuluri

  3. Department Of Surgical Oncology, Tata Memorial Hospital, E Borges Road, Parel, Mumbai, 400012, India

    Esha Pai

  4. Department of Biostatistics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005, India

    T. B. Singh

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  1. Tarun Kumar
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  2. Ravi Krishanappa
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  3. Esha Pai
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  4. Raxith Sringeri
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  5. T. B. Singh
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Correspondence to Tarun Kumar.

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Kumar, T., Krishanappa, R., Pai, E. et al. Completely Linear Stapled Versus Handsewn Cervical Esophagogastric Anastomosis After Esophagectomy. Indian J Surg 80, 134–139 (2018). https://doi.org/10.1007/s12262-018-1732-5

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  • DOI: https://doi.org/10.1007/s12262-018-1732-5

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