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Clinical Application of Layered Anastomosis During Esophagogastrostomy

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Abstract

The aim of this study was to compare the operative results in regard to reducing anastomotic leakage and stricture formation using a newly designed layered manual esophagogastric anastomosis versus a stapler esophagogastrostomy versus the conventional hand-sewn whole-layer anastomosis after resection for esophageal or gastric cardiac carcinoma. From January 2004 to September 2006, a total of 1024 patients with esophageal or gastric cardia carcinoma underwent a layered esophagogastric anastomosis with the assistance of a three-leaf clipper in a single university medical center. The mucosal layers of the esophagus and stomach were sutured continuously with 4/0 Vicryl plus antibacterial suture (polyglyconate). From May 2002 to December 2003, there were also 170 patients and 69 patients who underwent stapler and conventional whole-layer anastomosis, respectively; they served as control groups. The results were analyzed retrospectively. The operative mortality rate was 0.7% in the layered group compared to 5.9% and 7.2% for the stapler group and the whole-layer group (p < 0.01), The anastomotic leakage rates were 0%, 3.5%, and 5.8% for the layered group, stapler group, and whole-layer group, respectively (p < 0.01). All patients were followed postoperatively. Six patients in the layered group (0.6%) developed mild stricture formation compared to 16 patients in stapled group (9.9%) and 5 patients in the conventional whole-layer group (7.8%) (p < 0.01). The application of layered esophagogastric anastomosis could reduce the incidence of anastomotic leakage and stricture after esophagectomy compared with the stapler and whole-layer manual anastomoses. It is easy to apply and could be used as an alternative for esophagogastric anastomosis after resection for esophageal or cardiac carcinoma.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, West China Hospital, Sichuan University, 37 Guoxuexiang, Chengdu, Sichuan, 610041, China

    Zi-Jiang Zhu, Yong-Fan Zhao, Long-Qi Chen, Yang Hu, Lun-Xu Liu, Yun Wang & Ying-Li Kou

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  1. Zi-Jiang Zhu
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  2. Yong-Fan Zhao
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  3. Long-Qi Chen
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  4. Yang Hu
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  5. Lun-Xu Liu
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  6. Yun Wang
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  7. Ying-Li Kou
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Correspondence to Yong-Fan Zhao.

Additional information

This abstract was accepted as a free paper and oral presentation at International Surgical Week 2007, Abstract 320, Montreal, Canada, August 2007

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Zhu, ZJ., Zhao, YF., Chen, LQ. et al. Clinical Application of Layered Anastomosis During Esophagogastrostomy. World J Surg 32, 583–588 (2008). https://doi.org/10.1007/s00268-007-9396-5

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  • DOI: https://doi.org/10.1007/s00268-007-9396-5

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