Singhal Saurabh, Kailasam Aparna, Akimoto Shunsuke, Masuda Takahiro, Bertellotti Carrie, Mittal Sumeet K
1 Norton Thoracic Institute, Dignity Health, Creighton University School of Medicine , Phoenix, Arizona.
2 Department of Surgery, Creighton University School of Medicine , Creighton Univesity Medical Center, Omaha, Nebraska.
J Laparoendosc Adv Surg Tech A. 2017 Mar;27(3):288-294. doi: 10.1089/lap.2016.0443. Epub 2016 Oct 5.
Advent of minimally-invasive esophagectomy necessitated the incorporation of stapled anastomotic techniques especially for intrathoracic anastomosis. We present our approach to the Ivor Lewis esophagectomy highlighting a simple modification in the anastomotic technique and review our experience with anastomotic outcomes.
With IRB approval, patients who underwent Ivor Lewis esophagectomy with circular-stapled end-to-end anastomosis (EEA) were identified, divided into three equal sequential cohorts (A, B, and C), and compared for perioperative outcome. Cohorts were divided in a chronological order to have equal number of patients in each group.
Seventy-five patients underwent Ivor Lewis esophagectomy with circular stapled (EEA-25/28) anastomosis. Group A had longer median postoperative hospital stay and median postoperative ICU stay compared to Groups B and C. Ten patients (13%) had anastomotic leak-one patient required redo-anastomosis and other patients were managed with endoscopic interventions. There was significant decrease in rate of anastomotic leak with experience (8 versus 1 versus 1, P = .004). There were two perioperative deaths, one each in Groups A and C, including one death due to anastomotic leak (Group A).
Use of simple modifications to stapled EEA, as described here, has led to decrease in anastomotic leaks following Ivor Lewis esophagectomy.
微创食管切除术的出现使得吻合器吻合技术的应用成为必要，尤其是用于胸内吻合。我们介绍了我们进行艾弗·刘易斯食管切除术的方法，重点介绍了吻合技术中的一个简单改进，并回顾了我们在吻合结果方面的经验。
经机构审查委员会批准，确定接受艾弗·刘易斯食管切除术并采用圆形吻合器端端吻合（EEA）的患者，将其分为三个连续且人数相等的队列（A、B和C组），并比较围手术期结果。按时间顺序对队列进行分组，以使每组患者数量相等。
75例患者接受了艾弗·刘易斯食管切除术并采用圆形吻合器（EEA-25/28）吻合。与B组和C组相比，A组术后住院时间中位数和术后重症监护病房住院时间中位数更长。10例患者（13%）发生吻合口漏，1例患者需要再次吻合，其他患者接受内镜干预治疗。随着经验的积累，吻合口漏发生率显著降低（8例、1例、1例，P = 0.004）。围手术期有2例死亡，A组和C组各1例，其中1例因吻合口漏死亡（A组）。
如本文所述，对吻合器EEA进行简单改进可降低艾弗·刘易斯食管切除术后的吻合口漏发生率。
