Stapled anastomosis in esophageal resections with Chinese staplers: a retrospective study of 1965 consecutive cases.

OBJECTIVES

To investigate the safety and efficacy of mechanical anastomosis with Chinese staplers in the surgical treatment of esophageal carcinoma and carcinoma of gastric cardia in order to find out an alternative effective anastomotic technique to hand-sewn method.

METHODS

From August 1980 to April 1996, there were totally 1264 cases of esophageal carcinoma and 701 cases of carcinoma of gastric cardia receiving esophagogastric anastomosis with Chinese staplers combined with telescope suturing of seromuscular layers after resection of tumors, with age ranging from 28 years to 81 years and a man to woman ratio of 4:1 (1572/393). The anastomosis was performed at the cervical region in 44 patients, and intrathoracically in 1921. Our technical essential points also included fixation of the gastric substitute to the thoracic apex or mediastinum with 3-4 stitches to relieve the anastomotic tension.

RESULTS

Compared with the reported postoperative leakage rate from 2%-4% in China and 4.2%-12.3% abroad, our techniques reduced the total leakage rate to 0.8%, that is, cervical leakage rate was 11.4% (5/44), and intrathoracic leakage rate 0.57% (11/1921). The intrathoracic leakage rate was 0.99% (8/808) for the first 8 years, and 0.27% for the following 8 years. There was no leakage (0/350) in the last 3 years. There anastomotic stricture occurred in 98 patients (4.99%) which could be relieved by Bougie or balloon dilatation. The total operative mortality was reduced to 0.76%.

CONCLUSIONS

Mechanical anastomosis with Chinese staplers combined with telescope suturing should be an effective method to prevent the occurrence of anastomotic leakage after esophageal resections.