Abstract
Background
This study was performed to verify the superiority of a new “non-tensioning method” for avoiding stricture of the cervical esophagogastric anastomosis by circular stapling compared with the conventional method.
Methods
In total, 395 consecutive patients who underwent McKeown esophagectomy with gastric conduit (GC) reconstruction were reviewed. A 4 cm-wide GC was created and pulled up at the cervical site through the retrosternal route. The esophagogastrostomy site of the GC was planned as far caudally as possible on the greater curvature side. In the conventional technique, the stapler was fired while pulling the GC to avoid tissue slack. In the non-tensioning technique, the stapler was fired through the natural thickness of the stomach wall. The length of the blind end was changed from 4 to 2 cm in the non-tensioning technique. Anastomotic leakage and stricture formation were compared between the two techniques, and adjustment was performed using propensity score matching.
Results
The conventional group comprised 315 patients, and the non-tensioning group comprised 80 patients. Anastomotic leakage occurred in 22 (7%) and 2 (2.5%) patients, respectively (P = 0.134) [and in 9 (2.9%) and 2 (2.5%) patients, respectively, if leakage at the blind end was excluded]. Anastomotic stricture occurred in 92 (29.2%) and 3 (3.8%) patients, respectively (P < 0.001). The propensity score-matching analysis including 79 pairs of patients confirmed a lower stricture rate in the non-tensioning than conventional group (2.5% vs. 29.1%, P < 0.001).
Conclusions
The non-tensioning technique significantly reduced the incidence of anastomotic stricture compared with the conventional technique.
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We thank Angela Morben, DVM, ELS, from Edanz for editing a draft of this manuscript.
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Supplementary Information
Fig. S1
Procedure used to create gastric conduit. (a) The first cut from the lesser curvature was performed with a curved cutter-stapler device. (b–e) The stomach was then sequentially cut off with a linear cutter according to the straightened distance based on the stretched greater curvature.(PNG 4225 kb)
Fig. S2
(a) In some cases, narrow ring-shaped necrosis of the staple line was confirmed by endoscopic observation around 7 days after surgery with the conventional method. (b) No ring-shaped necrosis was observed in the non-tensioning method.(PNG 4474 kb)
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Shiraishi, O., Yasuda, T., Kato, H. et al. Circular Stapler Method for Avoiding Stricture of Cervical Esophagogastric Anastomosis. J Gastrointest Surg 26, 725–732 (2022). https://doi.org/10.1007/s11605-022-05266-4
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DOI: https://doi.org/10.1007/s11605-022-05266-4