Terminalized Semimechanical Side-to-Side Suture Technique for Cervical Esophagogastrostomy

Abstract

Background. The classic manual end-to-side technique of esophagogastrostomy after gastric pull-up to the neck carries a rather high risk of fistula and stricture.Methods. A terminalized semimechanical side-to-side technique of cervical esophagogastrostomy was performed in 16 patients by the application of an Endo-GIA stapler across the gastric and esophageal walls placed side by side, so as to create a V-shaped posterior opening between the two lumina. The anterior aspect of the anastomosis was hand-sewn using a classic running suture. The cross-sectional area of the semimechanical anastomoses was estimated by barium swallow study 2 months after operation and compared with that of 24 manual end-to-side esophagogastrostomies.Results. The cross-sectional area was 225 ± 15.7 mm2 (mean ± standard error of the mean) for the 16 semimechanical anastomoses versus 136 ± 15 mm2 for the 24 manual anastomoses (p = 0.0001). The anastomotic area decreased from 206.6 ± 13.5 mm2 in 29 patients without dysphagia to 107.5 ± 4.7 mm2 in 7 patients with moderate dysphagia for solids that did not require endoscopic dilation and to 55.7 ± 16 mm2 in 4 patients with severe dysphagia that required dilation (p = 0). The anastomotic area in 6 of the 7 patients with initial moderate dysphagia for solids increased spontaneously with time from 107.3 ± 5.5 mm2 to 174.6 ± 8.1 mm2, with concomitant symptomatic relief (p = 0.0277).Conclusions. The terminalized semimechanical side-to-side suture technique produces a larger anastomosis than the classic end-to-side esophagogastrostomy technique. Inflammatory changes related to the operation may cause transient narrowing of a cervical esophagogastrostomy.