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Functional and menometric study of side-to-side stapled anastomosis and traditional hand-sewn anastomosis in cervical esophagogastrostomy

Thoracic Surgery Department, Daping Hospital, Third Military Medical University, Chongqing City 400042, PR China

Received 26 May 2008; received in revised form 10 August 2008; accepted 8 September 2008.

^_* Corresponding author. Address: Thoracic Surgery Department, Daping Hospital, Third Military Medical University, Changjiang Branch St, 10#, Yuzhong District, Chongqing City 400042, PR China. Tel.: +86 2360715441; fax: +86 2368816736. (Email: superdb{at}163.com).

Objective: In the study, we made the pharyngoesophageal functional assessment and menometric study on the two kinds of anastomosis (traditional hand-sewn anastomosis and side-to-side stapled anastomosis) for the further evaluation and application of cervical esophagogastrostomy. Patients: The study included 17 patients with esophageal squamous cancer from March 2006 to May 2008. Eight patients had undergone total esophagectomy and traditional hand-sewn technique in CEGA. The other nine patients had undergone total esophagectomy and side-to-side stapled technique in CEGA. All the 17 patients were studied for 3 months after the operations. The complete data, such as esophagogastroscopy, barium swallow and manometric studies, were obtained for each participating patient. Results: In the hand-sewn group of eight patients, four patients (50%) reported clinical significant symptoms of cervical dysphagia. Two patients (11.1%) reported clinical significant symptoms of cervical dysphagia in the side-to-side group of nine patients. There is a statistically significant difference between the hand-sewn group of patients (n = 8) and the side-to-side group of patients (n = 9) with respect to overall mean anastomotic diameters (1.688 ± 0.26 cm vs 3.012 ± 0.17 cm, p = 2.10 x 10^–8). In the eight patients who underwent hand-sewn technique, there were four symptomatic patients with poor menometric datum, such as anastomotic hypertensive peristaltic activity, confusing inversion of anastomotic and midcervical esophageal pressure, and consequently poor compliance of the pharyngoesophageal segment (pharyngeal shoulder pressure). By contrast, there was only one symptomatic patient with poor menometric data in the nine patients who underwent side-to-side technique. Conclusion: The side-to-side stapled technique is conducive to decrease complications of postoperative dysphagia and is helpful for improving pharyngesophageal and anastomotic menometric function. The anastomotic technique deserves more attention and further applications.

Key Words: Esophageal cancer • Cervical esophagogastric anastomisis • Hand-sewn anastomisis • Side-to-side stapled anastomosis