Comparison of Postoperative Outcomes of Hand-Sewn Versus Stapled Esophago-jejunal Anastomosis During Total Gastrectomy for Gastric Cancer in 72 Patients: A Retrospective, Single-Center Study in Poland

Abstract

Background:Mechanical stapling is a commonly used alternative to hand-sewn technique for esophago-jejunal anastomosis in total gastrectomy (TG). Some studies report reduction in postoperative complications in the stapler group. This retrospective study aimed to compare short-and long-term surgical outcomes between the groups with stapled and hand-sewn esophago-jejunal anastomosis (EJA) during open TG for gastric cancer. Material/Methods:The study included 72 adult patients with gastric cancer who underwent TG in the Department of Digestive Tract Surgery in Katowice between May 2018 and December 2021. The patients were divided into 2 groups according to the technique of EJA: stapled (44 cases) or hand-sewn (28 cases). We compared the groups in terms of the duration of the surgery, length of hospital stay, and occurrence of complications (focusing on anastomotic leakage, stricture and abdominal abscess). Results:There were no significant differences in duration of the surgery (P=0.6), blood loss (P=0.7), or length of postoperative hospital stay (P=0.2) among the groups. Early postoperative complications rates were 9.1% (4/44) in the stapler group and 17.9% (5/28) in the hand-sewn group (P=0.27). The most frequent complication was anastomotic leakage, with 2 cases in each group (P=0.76). The mean follow-up time was 1.8±0.9 (0.3-3.6) years. During this period the anastomotic stricture occurred in 7 (15.9%) cases with stapled anastomosis and in 5 (17.9%) cases with hand-sewn anastomosis (P=0.52). Conclusions:In this study there were no significant differences in mortality, morbidity, and surgery duration between stapled and hand-sewn esophago-jejunal anastomosis in total gastrectomy.

Anastomotic Leakage after Gastrectomy for Gastric Cancer

“…• Hand-sewn technique for esophago-jejunal anastomosis in total gastrectomy seemed similar with stapler anastomosis in terms of mortality, morbidity and postoperative complications [58].…”

Long‐term nutrition alterations after surgery for gastrointestinal cancers

“…Over time, GI anastomoses can develop strictures, or benign narrowing related to mechanical, ischemic or inflammatory factors 53–55 . Specific surgical technique, such as stapled or hand sewn construction has little impact on the development of strictures 56,57 . The development of a postoperative anastomotic dehiscence or leak is associated with stricture formation in the long term.…”

“…The development of a postoperative anastomotic dehiscence or leak is associated with stricture formation in the long term. The incidence of strictures depends on the location of the anastomosis and the anastomosed portions of the GI tract, with esophago‐gastric anastomosis structuring at a very high rate of about 30%, 53 followed by 17% for esophago‐jejunal anastomosis after total gastrectomy 57 . Anastomotic strictures tend to occur within 1 year of surgery must have been reported as early as a few weeks after surgery 55 .…”

“…[53][54][55] Specific surgical technique, such as stapled or hand sewn construction has little impact on the development of strictures. 56,57 The development of a postoperative anastomotic dehiscence or leak is associated with stricture formation in the long term.…”

“…The incidence of strictures depends on the location of the anastomosis and the anastomosed portions of the GI tract, with esophago-gastric anastomosis structuring at a very high rate of about 30%, 53 followed by 17% for esophago-jejunal anastomosis after total gastrectomy. 57 Anastomotic strictures tend to occur within 1 year of surgery must have been reported as early as a few weeks after surgery. 55 Nonanastomotic operative strictures can occur as a result of ischemia or adhesions.…”