Esophageal Delta-Shaped Anastomosis: A New Method of Stapled Anastomosis for the Cervical Esophagus and Digestive Tract

Abstract

We describe a new technique of anastomosis between the esophagus and digestive tract, developed as an extension of a functional end-to-end anastomosis, and named the "esophageal delta-shaped anastomosis." We also report its short-term clinical results. We used this anastomotic technique in nine patients undergoing surgery for thoracic esophageal carcinoma. The reconstruction route was posterior mediastinal (n = 5), antethoracic (n = 3), or retrosternal (n = 1), and the organs for esophageal replacement were the gastric tube (n = 7) or the colon (n = 2). When using the gastric tube, a linear stapler is inserted into two intestinal windows; one created at the stump of the esophagus and the other created in the posterior wall near the greater curvature of the gastric tube. The stapler is fired, ensuring that the staple line does not sharply cross the staple line of the lesser curvature of the gastric tube. Two linear staplers are then used to close the window transversally to form a delta shape. There were no complications related to the anastomosis. The esophageal delta-shaped anastomosis is a simple and safe method for esophagogastrostomy or esophagoenterostomy, which uses a combination of introverted and extroverted stapling, resulting in a larger lumen not limited by the lumen of the esophagus or the organs used for esophageal replacement.