Linear stapled esophagogastrostomy is more effective than hand-sewn or circular stapler in prevention of anastomotic stricture: a comparative clinical study.

OBJECTIVE

The aim of this study was to retrospectively compare the operative effects of linear stapled intrathoracic esophagogastrostomy with hand-sewn or circular stapled anastomosis in prevention of anastomotic stricture.

METHOD

Between October 2007 and October 2009, 293 patients with esophageal or gastric cardia cancer underwent a curative intent resection. Patients received either a linear stapled (LS group, n = 166), conventional hand-sewn (HS group, n = 59), or circular stapled intrathoracic esophagogastric anastomosis (CS group, n = 68). The patients were followed-up and compared at 3 months after the operation.

RESULT

Three groups of patients were comparable on clinical baseline characteristics. There was one operative death in the HS group. The operative complications were documented in 15 patients (5.1%), with no difference among three groups (χ(2) = 2.215, P = 0.330). The follow-up rate was 96.9%. The anastomotic diameter was 1.6 ± 0.4 cm in the LS group, 1.2 ± 0.3 cm in the HS group, and 1.0 ± 0.4 cm in the CS group, respectively (F = 58.110, P < 0.001). The anastomotic stricture rates were 1.9% (3/162) in the LS group, 9.3% (5/54) in the HS group, and 20.9% (14/67) in the CS group, respectively (χ(2) = 24.095, P < 0.001). The reflux score in LS group was lower than other two groups (H = 6.995, P = 0.030).

CONCLUSION

The linear stapled esophagogastrostomy could decrease anastomotic stricture without increasing gastroesophageal reflux.