The influence of side-to-side stapled esophagogastric anastomosis on the postoperative anastomotic complications among patients undergoing esophagectomy

Ahmed Daoud; Moustafa Elhamami; Walid Abu Arab

Ahmed Daoud Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Moustafa Elhamami Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Walid Abu Arab Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Keywords: Esophagectomy, Anastomosis, Side-to-side, Esophagogastric, Stapled

Abstract

Background: Esophageal cancer is among the most challenging tumors facing thoracic surgeons that entails a highly complex surgical procedure carrying a very high rate of morbidity and mortality. Esophagectomy procedure could be completed using several techniques depending on many factors like tumor location and surgeon preference. There are different techniques for anastomosis construction either stapled or hand sewn and there is a big debate about the ideal method for anastomosis regarding the technique and the location of construction. Our study aimed to clarify the feasibility of performing a side to side stapled cervical esophagogastric anastomosis and to study its effect on the short term outcomes after surgery.

Methods: We have conducted a prospective study for 29 consecutive patients diagnosed with esophageal carcinoma and who received esophagectomy as a curative treatment starting from January 2020 to January 2024. The study was held in Alexandria Main University Hospital.

Results: The mean age for our study group was 63.34 years ±5.31 years and females represented about 34.5%. Regarding tumor location, 13 patients (44.8%) had lower third esophageal tumor, 9 patients (31%) had middle third neoplasm, and 7 patients (24.1%) had gastroesophageal junction tumor. Regarding the anastomotic technique used, circular stapled anastomosis was done in 21 patients (72.41%). Hand sewn cervical anastomosis was used in 5 patients (17.24%) and side to side stapled cervical anastomosis was used in 3 patients (10.34%). Correlation between type of anastomosis and occurrence of leakage and dysphagia showed that anastomotic leakage has occurred in one patient with circular stapled anastomosis and in 2 patients with hand sewn anastomosis, while the side to side stapled anastomosis was not associated with any cases of leakage. Regarding the dysphagia resulting from anastomotic stricture, the side to side stapled anastomosis was not associated with dysphagia on the follow up period, while dysphagia has occurred in one patient with circular stapled anastomosis and another patient with handsewn anastomosis.

Conclusion: Side to side stapled esophagogastric anastomosis is a feasible technique and it could be associated with reduced incidence of early postoperative anastomotic leakage as well as reduced rates of late postoperative anastomotic stricture and dysphagia.