Castaño Llano Rodrigo, Salazar Ochoa Santiago, Piñeres Salazar Amy Del Mar, Jaramillo Ricardo, Molina Sandra, Aristizábal Arjona Felipe, Puerta Botero Juan Esteban
Grupo de Gastrohepatología, Universidad de Antioquia. Medellín, Colombia; Instituto de Cancerología, Clínica Las Américas. Medellín, Colombia.
Universidad Pontificia Bolivariana. Medellín, Colombia.
Rev Gastroenterol Peru. 2021 Apr-Jun;41(2):65-72.
The scarce existing literature suggests having a lower rate of anastomotic leakage and less late stricture formation after stapled esophagogastric anastomosis compared to the manual anastomosis technique. The aim of the present study is to compare the surgical outcomes of termino-lateral manual cervical anastomosis versus mechanical anastomosis by later lateral stapling, after transhiatal esophagectomy for cancer.
A retrospective review of patients undergoing transhiatal esophagectomy with manual or mechanical anastomosis for neoplasia was performed at three institutions in Medellin, between 2011 and 2018. Endpoints included leak rate, morbidity, mortality, hospital stay, and endoscopically identified anastomotic strictures requiring dilatation.
68 patients (40 men, 59%) were evaluated, 37 with manual anastomosisand 31 with mechanical anastomosis with similar demographic characteristics. Anastomotic leaks occurred in 13 patients (19.1%), with no difference found between manual and mechanical anastomosis (18.9 vs. 19.3%; p=0.93). Overall morbidity (61%), in-hospital mortality (3%) and length of hospital stay (median 12 days) were not affected by anastomotic technique. Follow-up endoscopic evaluation was available in all patients and anastomotic stricture associated or not with leak was detected in 18 patients (22%), in cases of stricture without leak is more frequent with manual than mechanical anastomosis technique (21.6 vs 6.4%; p=0.07) with longer duration of surgical procedure in case of manual anastomosis (p=0.05).
Our non-randomized study suggests that the manual anastomosis technique results in a shorter surgical time and a lower stricture rate than mechanical anastomosis in cervical esophagogastric reconstruction after transhiatal esophagectomy, with a similar rateof leakage, hospital stay and morbidity and mortality.
现有文献稀少，提示与手工吻合技术相比，吻合器食管胃吻合术后吻合口漏发生率较低，晚期狭窄形成较少。本研究的目的是比较经胸食管癌切除术后，端侧手工颈部吻合与侧侧吻合器机械吻合的手术效果。
对2011年至2018年在麦德林的三家机构接受经胸食管癌切除术并采用手工或机械吻合治疗肿瘤的患者进行回顾性研究。观察指标包括漏率、发病率、死亡率、住院时间以及内镜检查发现的需要扩张的吻合口狭窄。
评估了68例患者（40例男性，占59%），37例行手工吻合，31例行机械吻合，两组患者人口统计学特征相似。13例患者（19.1%）发生吻合口漏，手工吻合与机械吻合之间无差异（18.9%对19.3%；p=0.93）。总体发病率（61%）、住院死亡率（3%）和住院时间（中位数12天）不受吻合技术影响。所有患者均接受了随访内镜评估，18例患者（22%）检测到与漏相关或无关的吻合口狭窄，在无漏的狭窄病例中，手工吻合技术比机械吻合技术更常见（21.6%对6.4%；p=0.07），手工吻合的手术时间更长（p=0.05）。
我们的非随机研究表明，在经胸食管癌切除术后的颈部食管胃重建中，手工吻合技术比机械吻合技术手术时间更短，狭窄率更低，漏率、住院时间、发病率和死亡率相似。
