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Anastomosen im oberen Gastrointestinaltrakt

Anastomoses in the upper gastrointestinal tract

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Zusammenfassung

Hintergrund

Das Anastomosen-Leak stellt die wichtigste postoperative chirurgische Komplikation dar und ist v. a. durch unzureichende Perfusion bei der Anastomosenanlage bedingt. Ziel dieser Arbeit war es, eine Übersicht zusammenzustellen, die die Anlagemethoden und deren Risikofaktoren für Leakagen und Strikturen beschreibt.

Methoden

Eine Pubmed-Recherche unter Verwendung folgender Suchbegriffe wurde durchgeführt: esophagogastric/esophagojejunal anastomosis, gastrojejunostomy, gastric bypass, esophagectomy, anastomotic leak/risc factors, gastrectomy, TEA, fluid management, early enteral feeding, reinforcement. Englische und deutsche Arbeiten wurden inkludiert und rezente prospektiv randomisierte kontrollierte Studien mit großer Fallzahl und Metaanalysen bevorzugt.

Schlussfolgerung

Es gibt keine Evidenz, um die händische oder maschinelle Anastomosenanlage zu empfehlen. Chirurgisches Können und Routine sowie sorgfältiges Arbeiten reduzieren Komplikationen. Stapler bringen eine Einheitlichkeit der Anastomosen, können aber chirurgische Defizite nicht kompensieren.

Abstract

Background

Anastomotic leaks are the major postoperative complications mainly due to technical difficulties. The aim was to review anastomotic techniques and risk factors for leak development.

Methods

A Pubmed search was perfomed using the terms esophagogastric/esophagojejunal anastomosis, gastrojejunostomy, gastric bypass, esophagectomy, anastomotic leak/risk factors, gastrectomy, TEA, fluid management, early enteral feeding and reinforcement. English and German literature sources were included with the accent on recent prospective randomized controlled trials (pRCT) with high numbers of cases as well as meta-analyses.

Conclusions

There is not enough evidence to recommend either hand sewn or mechanical anastomoses. Surgical skills and routine as well as precise work are necessary to reduce complications. Although stapling leads to uniformity of anastomoses it cannot compensate for surgical deficits.

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Abbreviations

BPS:

bovine pericardium strip

CA:

zervikale Anastomose

C-I:

Koloninterponat

G-J:

Gastrojejunostomie

ITA:

intrathorakale Anastomose

J-I:

Jejunuminterponat

(N)RCT:

(nicht) randomisierte klinische Studien

Ö-G:

Ösophagogastrostomie

Ö-J:

Ösophagojejunostomie

PRT:

prospektive Studien

TEA:

thorakale Epiduralanästhesie

Literatur

  1. Angrisani L, Lorenzo M, Borrelli V et al (2004) The use of bovine pericardial strips on linear stapler to reduce extraluminal bleeding during laparoscopic gastric bypass: prospective randomized clinical trial. Obes Surg 14(9):1198–1202

    Article  PubMed  Google Scholar 

  2. Aslam V, Bilal A, Khan A, Bilal M et al (2008) Gastroesophageal anastomosis: single-layer versus double-layer technique – an experience on 50 cases. J Ayub Med Coll Abbottabad 20(3):6–9

    PubMed  Google Scholar 

  3. Baigrie RJ, Devitt PG, Watkin DS (1996) Enteral versus parenteral nutrition after oesophagogastric surgery: a prospective randomized comparison. Aust N Z J Surg 66(10):668–670

    Article  CAS  PubMed  Google Scholar 

  4. Beitler AL, Urschel JD (1998) Comparison of stapled and hand-sewn esophagogastric anastomoses. Am J Surg 175(4):337–340

    Article  CAS  PubMed  Google Scholar 

  5. Bhat MA, Dar MA, Lone GN, Dar AM (2006) Use of pedicled omentum in esophagogastric anastomosis for prevention of anastomotic leak. Ann Thorac Surg 82(5):1857–1862

    Article  PubMed  Google Scholar 

  6. Blackmon SH, Correa AM, Wynn B et al (2007) Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg 83(5):1805–1813

    Article  PubMed  Google Scholar 

  7. Blewett CJ, Miller JD, Young JE et al (2001) Anastomotic leaks after esophagectomy for esophageal cancer: a comparison of thoracic and cervical anastomoses. Ann Thorac Cardiovasc Surg 7(2):75–78

    CAS  PubMed  Google Scholar 

  8. Blochle C, Mann O, Stenger AM et al (2001) [Gastric substitute following gastrectomy]. Zentralbl Chir 126 (Suppl 1):22–25

    Article  PubMed  Google Scholar 

  9. Bohdjalian A, Langer FB, Kranner A et al (2010) Circular- vs. linear-stapled gastrojejunostomy in laparoscopic Roux-en-Y gastric bypass. Obes Surg 20(4):440–446

    Article  PubMed  Google Scholar 

  10. Briel JW, Tamhankar AP, Hagen JA et al (2004) Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition. J Am Coll Surg 198(4):536–542

    Article  PubMed  Google Scholar 

  11. Chasseray VM, Kiroff GK, Buard JL, Launois B (1989) Cervical or thoracic anastomosis for esophagectomy for carcinoma. Surg Gynecol Obstet 169(1):55–62

    CAS  PubMed  Google Scholar 

  12. Cooper SC, Hulley CM, Grimley CE et al (2006) Perioperative peripheral parenteral nutrition for patients undergoing esophagectomy for cancer: a pilot study of safety, surgical, and nutritional outcomes. Int Surg 91(6):358–364

    PubMed  Google Scholar 

  13. Daryaei P, Vaghef Davari F et al (2009) Omission of nasogastric tube application in postoperative care of esophagectomy. World J Surg 33(4):773–777

    Article  PubMed  Google Scholar 

  14. De Giacomo T, Francioni F, Venuta F et al (2004) Complete mechanical cervical anastomosis using a narrow gastric tube after esophagectomy for cancer. Eur J Cardiothorac Surg 26(5):881–884

    Article  Google Scholar 

  15. Downey DM, Ali S, Goldblatt MI et al (2007) Gastrointestinal staple line reinforcement. Surg Technol Int 6:55–60

    Google Scholar 

  16. Edwards MA, Jones DB, Ellsmere J et al (2007) Anastomotic leak following antecolic versus retrocolic laparoscopic Roux-en-Y gastric bypass for morbid obesity. Obes Surg 17(3):292–297

    Article  PubMed  Google Scholar 

  17. Ercan S, Rice TW, Murthy SC et al (2005) Does esophagogastric anastomotic technique influence the outcome of patients with esophageal cancer? J Thorac Cardiovasc Surg 129(3):623–631

    Article  PubMed  Google Scholar 

  18. Fujimoto S, Takahashi M, Endoh F et al (1991) Stapled or manual suturing in esophagojejunostomy after total gastrectomy: a comparison of outcome in 379 patients. Am J Surg 162(3):256–259

    Article  CAS  PubMed  Google Scholar 

  19. Gabor S, Renner H, Matzi V et al (2005) Early enteral feeding compared with parenteral nutrition after oesophageal or oesophagogastric resection and reconstruction. Br J Nutr 93(4):509–513

    Article  CAS  PubMed  Google Scholar 

  20. Gertler R, Rosenberg R, Feith M et al (2009) Pouch vs. no pouch following total gastrectomy: meta-analysis and systematic review. Am J Gastroenterol 104(11):2838–2851

    Article  PubMed  Google Scholar 

  21. Gonzalez R, Lin E, Venkatesh KR et al (2003) Gastrojejunostomy during laparoscopic gastric bypass: analysis of 3 techniques. Arch Surg 138(2):181–184

    Article  PubMed  Google Scholar 

  22. Gonzalez R, Nelson LG, Gallagher SF, Murr MM (2004) Anastomotic leaks after laparoscopic gastric bypass. Obes Surg 14(10):1299–1307

    Article  PubMed  Google Scholar 

  23. Homesh NA, Alsabahi AA, Al-Agmar MH et al (2006) Transhiatal versus transthoracic resection for oesophageal carcinoma in Yemen. Singapore Med J 47(1):54–59

    CAS  PubMed  Google Scholar 

  24. Honkoop P, Siersema PD, Tilanus HW et al (1996) Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg 111(6):1141–1148

    Article  CAS  PubMed  Google Scholar 

  25. Hsu HH, Chen JS, Huang PM et al (2004) Comparison of manual and mechanical cervical esophagogastric anastomosis after esophageal resection for squamous cell carcinoma: a prospective randomized controlled trial. Eur J Cardiothorac Surg 25(6):1097–1101

    Article  PubMed  Google Scholar 

  26. Hur H, Si Y, Kang WK et al (2009) Effects of early oral feeding on surgical outcomes and recovery after curative surgery for gastric cancer: pilot study results. World J Surg 33(7):1454–1458

    Article  PubMed  Google Scholar 

  27. Hyodo M, Hosoya Y, Hirashima Y et al (2007) Minimum leakage rate (0.5%) of stapled esophagojejunostomy with sacrifice of a small part of the jejunum after total gastrectomy in 390 consecutive patients. Dig Surg 24(3):169–172

    Article  CAS  PubMed  Google Scholar 

  28. Ibele A, Garren M, Gould J (2010) Effect of circular staple line buttressing material on gastrojejunostomy failure in laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis 6(1):64–67

    Article  PubMed  Google Scholar 

  29. Jones WB, Myers KM, Traxler LB, Bour ES (2008) Clinical results using bioabsorbable staple line reinforcement for circular staplers. Am Surg 74(6):462–468

    PubMed  Google Scholar 

  30. Kataoka M, Masaoka A, Hayashi S et al (1989) Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy. Ann Surg 209(1):99–104

    Article  CAS  PubMed  Google Scholar 

  31. Kim RH, Takabe K (2010) Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol 101(6):527–533

    Article  PubMed  Google Scholar 

  32. Klink CD, Binnebosel M, Schneider M et al (2010) Operative outcome of colon interposition in the treatment of esophageal cancer: a 20-year experience. Surgery 147(4):491–496

    Article  PubMed  Google Scholar 

  33. Kondra J, Ong SR, Clifton J et al (2008) A change in clinical practice: a partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus 21(5):422–429

    Article  CAS  PubMed  Google Scholar 

  34. Law S, Fok M, Chu KM, Wong J (1997) Comparison of hand-sewn and stapled esophagogastric anastomosis after esophageal resection for cancer: a prospective randomized controlled trial. Ann Surg 226(2):169–173

    Article  CAS  PubMed  Google Scholar 

  35. Law S, Suen DT, Wong KH et al (2005) A single-layer, continuous, hand-sewn method for esophageal anastomosis: prospective evaluation in 218 patients. Arch Surg 140(1):33–39

    Article  PubMed  Google Scholar 

  36. Lehnert T, Buhl K (2004) Techniques of reconstruction after total gastrectomy for cancer. Br J Surg 91(5):528–539

    Article  CAS  PubMed  Google Scholar 

  37. Lin FC, Durkin AE, Ferguson MK (2004) Induction therapy does not increase surgical morbidity after esophagectomy for cancer. Ann Thorac Surg 78(5):1783–1789

    Article  PubMed  Google Scholar 

  38. Low DE, Kunz S, Schembre D et al (2007) Esophagectomy – it’s not just about mortality anymore: standardized perioperative clinical pathways improve outcomes in patients with esophageal cancer. J Gastrointest Surg 11(11):1395–1402

    Article  PubMed  Google Scholar 

  39. Luechakiettisak P, Kasetsunthorn S. (2008) Comparison of hand-sewn and stapled in esophagogastric anastomosis after esophageal cancer resection: a prospective randomized study. J Med Assoc Thai 91(5):681–685

    PubMed  Google Scholar 

  40. Martin LW, Swisher SG, Hofstetter W et al (2005) Intrathoracic leaks following esophagectomy are no longer associated with increased mortality. Ann Surg 242(3):392–402

    PubMed  Google Scholar 

  41. McManus KG, Ritchie AJ, McGuigan J et al (1990) Sutures, staplers, leaks and strictures. A review of anastomoses in oesophageal resection at Royal Victoria Hospital, Belfast 1977–1986. Eur J Cardiothorac Surg 4(2):97–100

    Article  CAS  PubMed  Google Scholar 

  42. Melis M, McLoughlin JM, Dean EM et al (2009) Correlations between neoadjuvant treatment, anemia, and perioperative complications in patients undergoing esophagectomy for cancer. J Surg Res 53(1):114–120

    Article  Google Scholar 

  43. Miller KA, Pump A. (2007) Use of bioabsorbable staple reinforcement material in gastric bypass: a prospective randomized clinical trial. Surg Obes Relat Dis 3(4):417–422

    Article  PubMed  Google Scholar 

  44. Nelson R, Edwards S, Tse B (2007) Prophylactic nasogastric decompression after abdominal surgery. Cochrane Database Syst Rev (3):CD004929

    Google Scholar 

  45. Ng JM (2008) Perioperative anesthetic management for esophagectomy. Anesthesiol Clin 26(2):293–304

    Article  PubMed  Google Scholar 

  46. Okuyama M, Motoyama S, Suzuki H et al (2007) Hand-sewn cervical anastomosis versus stapled intrathoracic anastomosis after esophagectomy for middle or lower thoracic esophageal cancer: a prospective randomized controlled study. Surg Today 37(11):947–952

    Article  PubMed  Google Scholar 

  47. Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230(3):392–403

    Article  CAS  PubMed  Google Scholar 

  48. Orringer MB, Marshall B, Iannettoni MD (2000) Eliminating the cervical esophagogastric anastomotic leak with a side-to-side stapled anastomosis. J Thorac Cardiovasc Surg 119(2):277–288

    Article  CAS  PubMed  Google Scholar 

  49. Pines G, Buyeviz V, Machlenkin S et al (2009) The use of circular stapler for cervical esophagogastric anastomosis after esophagectomy: surgical technique and early postoperative outcome. Dis Esophagus 22(3):274–278

    Article  CAS  PubMed  Google Scholar 

  50. Ribet M, Debrueres B, Lecomte-Houcke M (1992) Resection for advanced cancer of the thoracic esophagus: cervical or thoracic anastomosis? Late results of a prospective randomized study. J Thorac Cardiovasc Surg 103(4):784–789

    CAS  PubMed  Google Scholar 

  51. Rizk NP, Bach PB, Schrag D et al (2004) The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J Am Coll Surg 198(1):42–50

    Article  PubMed  Google Scholar 

  52. Santos RS, Raftopoulos Y, Singh D et al (2004) Utility of total mechanical stapled cervical esophagogastric anastomosis after esophagectomy: a comparison to conventional anastomotic techniques. Surgery 136(4):917–925

    Article  PubMed  Google Scholar 

  53. Schardey HM, Kramling HJ, Cramer C et al (1998) [Risk factors and pathogenic microorganisms in patients with insufficient esophagojejunostomy after gastrectomy]. Zentralbl Chir 123(1):46–52

    CAS  PubMed  Google Scholar 

  54. Schoppmann SF, Prager G, Langer FB et al (2010) Open versus minimally invasive esophagectomy: a single-center case controlled study. Surg Endosc (in press)

  55. Seufert RM, Hottenrott C, Schmidt-Matthiesen A (1987) [Controlled study comparing mechanical and manual esophago-jejunostomy following gastrectomy]. Langenbecks Arch Chir 371(4):235–242

    Article  CAS  PubMed  Google Scholar 

  56. Shikora SA (2004) The use of staple-line reinforcement during laparoscopic gastric bypass. Obes Surg 14(10):1313–1320

    Article  PubMed  Google Scholar 

  57. Shope TR, Cooney RN, McLeod J et al (2003) Early results after laparoscopic gastric bypass: EEA vs GIA stapled gastrojejunal anastomosis. Obes Surg 13(3):355–359

    Article  PubMed  Google Scholar 

  58. Sierzega M, Kolodziejczyk P, Kulig J (2010) Impact of anastomotic leakage on long-term survival after total gastrectomy for carcinoma of the stomach. Br J Surg 97(7):1035–1042

    Article  CAS  PubMed  Google Scholar 

  59. Silberhumer GR, Gyori G, Burghuber C et al (2009) The value of protecting the longitudinal staple line with invaginating sutures during esophageal reconstruction by gastric tube pull-up. Dig Surg 26(4):337–341

    Article  PubMed  Google Scholar 

  60. Silecchia G, Boru CE, Mouiel J et al (2008) The use of fibrin sealant to prevent major complications following laparoscopic gastric bypass: results of a multicenter, randomized trial. Surg Endosc 22(11):2492–2497

    Article  PubMed  Google Scholar 

  61. Tabatabai A, Hashemi M, Mohajeri G et al (2009) Incidence and risk factors predisposing anastomotic leak after transhiatal esophagectomy. Ann Thorac Med 4(4):197–200

    Article  PubMed  Google Scholar 

  62. Toh Y, Sakaguchi Y, Ikeda O et al (2009) The triangulating stapling technique for cervical esophagogastric anastomosis after esophagectomy. Surg Today 39(3):201–206

    Article  PubMed  Google Scholar 

  63. Urschel JD, Blewett CJ, Bennett WF et al (2001) Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer: meta-analysis of randomized controlled trials. Dis Esophagus 14(3/4):212–217

    Google Scholar 

  64. Urschel JD, Urschel DM, Miller JD et al (2001) A meta-analysis of randomized controlled trials of route of reconstruction after esophagectomy for cancer. Am J Surg 182(5):470–475

    Article  CAS  PubMed  Google Scholar 

  65. van Heijl M, van Wijngaarden AK, Lagarde SM et al (2010) Intrathoracic manifestations of cervical anastomotic leaks after transhiatal and transthoracic oesophagectomy. Br J Surg 97(5):726–731

    Article  Google Scholar 

  66. Walther B, Johansson J, Johnsson F et al (2003) Cervical or thoracic anastomosis after esophageal resection and gastric tube reconstruction: a prospective randomized trial comparing sutured neck anastomosis with stapled intrathoracic anastomosis. Ann Surg 238(6):803–814

    Article  PubMed  Google Scholar 

  67. Wormuth JK, Heitmiller RF (2006) Esophageal conduit necrosis. Thorac Surg Clin 16(1):11–22

    Article  PubMed  Google Scholar 

  68. Yo LS, Consten EC, Quarles van Ufford HM et al (2006) Buttressing of the staple line in gastrointestinal anastomoses: overview of new technology designed to reduce perioperative complications. Dig Surg 23(5/6):283–291

  69. Zhang YS, Gao BR, Wang HJ et al (2010) Comparison of anastomotic leakage and stricture formation following layered and stapler oesophagogastric anastomosis for cancer: a prospective randomized controlled trial. J Int Med Res 38(1):227–233

    CAS  PubMed  Google Scholar 

  70. Zhu ZJ, Zhao YF, Chen LQ et al (2008) Clinical application of layered anastomosis during esophagogastrostomy. World J Surg 32(4):583–588

    Article  PubMed  Google Scholar 

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Interessenkonflikt

Der korrespondierende Autor weist auf folgende Beziehungen hin: In den vergangenen 5 Jahren hat Prof. Zacherl finanzielle Unterstützung (Reise- und Unterbringungskosten zu Kongressen, Studienunterstützung oder Vortragshonorare) von folgenden Firmen erfahren: Ethicon, Covidien, Novartis, Cook, Micro-Tech Europe, Medigus.

Laufende Projekte (Testprotokolle, noch nicht abgerechnet) mit Cook Medical, Micro-Tech Europe.

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  1. Universitätsklinik für Chirurgie, Medizinische Universität Wien, AKH Wien, Währinger Gürtel 18-20, 1090, Wien, Österreich

    K. Schwameis &  J. Zacherl

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  1. K. Schwameis
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  2. J. Zacherl
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Correspondence to J. Zacherl.

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Schwameis, K., Zacherl, J. Anastomosen im oberen Gastrointestinaltrakt. Chirurg 82, 26–33 (2011). https://doi.org/10.1007/s00104-010-1900-z

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