Stapler vs. hand-sewn intrathoracic esophagogastric anastomosis: which anastomotic method renders better results?

Abstract

Aim: We investigated the impact of the anastomotic method in the frame of open abdominothoracic esophageal resection (hand-sewn vs. stapler anastomosis) in patients with carcinoma submitted to surgery in the University Clinic of Saarland over a 14-year period.

Methods: In total, 176 patients underwent an abdominothoracic resection with intrathoracic anastomosis and conventional gastric conduit formation; two groups of patients were analyzed: end-to-end, hand-sewn anastomosis (Group 1) and end-to-side, circular stapler anastomosis (Group 2). Both groups were compared regarding anastomotic leaks and strictures, postoperative morbidity, 90-day mortality and survival.

Results: The rates of anastomotic leak and stricture in the stapler group were reduced in comparison to hand-sewn group, however without reaching statistical significance (8% vs. 13.5%, P = 0.22, and 6% vs. 13.5%, P = 0.1, respectively). In contrast, the rates of redo surgery (34.1% vs. 8%, P = 0.001) and 90-day mortality (11.9% vs. 2%, P = 0.02) were significantly higher in the hand-sewn anastomosis group.

Conclusion: The management of anastomotic leak (stent insertion vs. reoperation) combined with the use of stapler to perform intrathoracic esophagogastric anastomosis improved the postoperative outcome after abdominothoracic esophageal resection.

Keywords

Esophagogastric anastomosis / circular stapler / Clavien-Dindo classification / anastomotic leak / gastric tube / esophagectomy / esophageal resection / Ivor-Lewis esophagectomy

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