Comparative Analysis of Late Results of Cervical Esophagogastric Anastomosis by Manual and Mechanical Suture in Patients Submitted to Esophageal Mucosectomy Through Advanced Megaesophagus

Abstract

Background:Among the anastomoses of the gastrointestinal tract, those of the esophagus are of special interest due to several anatomical or even general peculiarities. Aim:Evaluate retrospectively the results comparing mechanical vs. manual suture at cervical esophagogastric anastomosis in megaesophagus treatment. Methods:Were included 92 patients diagnosed with advanced megaesophagus with clinical conditions to undergo the surgery. All underwent esophageal mucosectomy, performing anastomosis of the esophagus stump with the gastric tube at the cervical level. In order to make this anastomosis, the patients were divided into two groups: group A (n=53) with circular mechanical suture, lateral end; group B (n=39) with manual suture in two sides, lateral end. In the postoperative period, an early evaluation was performed, analyzing local and systemic complications and late (average 5.6 y) analyzing deglutition. Results:Early evaluation: a) dehiscence of esophagogastric anastomosis n=5 (9.4%) in group A vs. n=9 (23.0%) in group B (p=0.0418); b) stenosis of esophagogastric anastomosis n=8 (15.1%) in group A vs. n=15 (38.4%) in group B (p=0.0105.); c) pulmonary infection n=5 (9.4%) in group A vs. n=3 (7.6%) in group B (p=1.0000.); d) pleural effusion n=5 (9.4%) in group A vs. n=6 (15.4%) in group B (p<0.518). Late evaluation showed that 86.4-96% of the patients presented the criteria 4 and 5 from SAEED, expressing effective swallowing mechanisms without showing significant differences among the groups. Conclusion:Cervical esophagogastric anastomosis by means of mechanical suture is more proper than the manual with lower incidence of local complications and, in the long-term evaluation, regular deglutition was acquired in both suture techniques in equal quality.

Salvage Esophagectomy in Advanced Esophageal Cancer

“…With the advent of mechanical sutures to perform anastomoses of the digestive tract, whether in benign or malignant conditions, perhaps this complication could be minimized in patients undergoing salvage esophagectomy. This is because this suture provides a better coaptation of the anastomotic stumps as it is double and inverted [48,49].…”

“…The management for the treatment of this complication is based on the severity of the dehiscence. If severe, early and in the thoracic region and with hemodynamic undermining, aggressive surgical intervention is mandatory; however, if this complication occurs later, usually after the fifth postoperative day and in the cervical region, the conduct may be more conservative, with drainage of the cervical region at the bedside [43,45,48,49]. However, conservative management of this complication after salvage esophagectomy can often be unsuccessful if the tissue bed at the level of the anastomosis has been irradiated [18,21,29].…”