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Application of overlap anastomosis in digestive tract reconstruction during minimally invasive Ivor-Lewis esophagectomy

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Abstract

This study aims to assess the feasibility of the Overlap anastomosis technique in minimally invasive Ivor-Lewis esophagectomy. An accompanying video presentation elucidates our surgical procedures. A retrospective review of 46 patients diagnosed with middle and lower esophageal cancer was conducted. These patients underwent minimally invasive Ivor-Lewis esophagectomy with Overlap anastomosis between January 2019 and December 2020. A consistent team of surgeons performed all procedures. The initial phase involved laparoscopic stomach mobilization, intra-abdominal lymphadenectomies, and preparation of the tubular stomach. Subsequently, with the patient in the left decubitus position, thoracoscopy was used to dissect the esophagus, excise the diseased segment, and conduct mediastinal lymph node dissection. The final stage encompassed the intrathoracic gastroesophageal anastomosis using the Overlap method. All surgeries were completed without converting to an open approach, achieving complete resection. There were no operative fatalities, with an average surgery duration of 259.4 min. Average statistics included intraoperative blood loss of 92.3 ml, 16.2 lymph nodes dissected, and a postoperative hospital stay of 10.3 days. Postoperative complications comprised three instances of hoarseness due to recurrent laryngeal nerve palsy, two cases of aspiration pneumonia, one occurrence of chylothorax, and one gastric emptying disorder. Anastomotic technique-related complications were minimal, with only one patient experiencing an anastomotic leak that resolved spontaneously and two patients facing anastomotic stenosis, which was subsequently alleviated. Our findings posit that the Overlap anastomosis method is safe and efficient for minimally invasive Ivor-Lewis esophagectomy, marked by a notably low rate of anastomosis-related complications. Further evaluation of its long-term implications remains necessary.

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Data availability

The data supporting this study's findings are available from the corresponding author upon reasonable request.

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Acknowledgements

This project was supported by Universities scientific research project of Anhui Province (KJ2021A0313).

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  1. Jifei Ding and Chen Dai contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, The Second Hospital of Anhui Medical, University, Hefei, 230601, People’s Republic of China

    Jifei Ding, Wei Cao & Xudong Zhao

  2. Department of Chest Surgery, Aunhui Chest Hospital, Hefei, China

    Chen Dai

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  1. Jifei Ding
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  2. Chen Dai
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  4. Xudong Zhao
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Correspondence to Xudong Zhao.

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Ethical statement

The Ethics Committee of the Second Hospital of Anhui Medical University approved the study and complied with the ethical standards. Informed consent was obtained from all individual participants involved in the study. The study did not include animals.

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Ding, J., Dai, C., Cao, W. et al. Application of overlap anastomosis in digestive tract reconstruction during minimally invasive Ivor-Lewis esophagectomy. Updates Surg 76, 495–503 (2024). https://doi.org/10.1007/s13304-023-01642-0

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  • DOI: https://doi.org/10.1007/s13304-023-01642-0

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