Linear Stapled Esophagogastrostomy is more Effective than Hand-Sewn or Circular Stapler in Prevention of Anastomotic Stricture: a Comparative Clinical Study

Xu, Qiang; Wang, Kangning; Wang, Wenping; Zhang, Kun; Chen, Long-Qi

doi:10.1007/s11605-011-1490-1

Cited by 51 publications

(36 citation statements)

References 24 publications

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“…The application of endoscopic linear stapler for CEGA has effectively reduced anastomotic complications compared to conventional hand-sewn anastomosis [4–6, 9]. Several studies showed that linear stapled technique had a lower frequency of anastomotic stenosis than CSA [8, 11, 18]. The DSA technique has been reported since 2005 [13].…”

Section: Discussionmentioning

confidence: 99%

A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy

Huang

Zhuang

et al. 2017

World J Surg Onc

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BackgroundThe delta-shaped anastomosis has been reported to reduce anastomotic complications for a decade. However, little has been written comparing this technique with the circular stapler technique. The objective of this retrospective study was to assess the safety and efficacy of cervical delta-shaped anastomosis after esophagectomy.MethodsMedical records of patients with esophageal squamous cell carcinoma who underwent McKeown (three-incision) esophagectomy between September 2013 and June 2015 were reviewed. Either circular stapled anastomosis (CSA) or delta-shaped anastomosis (DSA) was performed at the cervical stage. The clinical characteristics and short-term outcome were retrospectively assessed to identify the differences between the two groups.ResultsA total of 81 patients were included in this study. The clinical characteristics were similar between the two groups. Cervical anastomotic leakage occurred in 3 (7.7%) of 39 patients in the DSA group and in 8 (19%) of 42 patients in the CSA group (P = 0.197). The average anastomotic orifice width was 16.1 ± 4.9 mm and 11.7 ± 2.2 mm, respectively (P < 0.001). The incidence of anastomotic stenosis was 2.6% (1/39) and 23.5% (10/42) in the DSA and CSA groups, respectively (P = 0.007). There was no significant difference in surgical duration, blood loss, pulmonary complication, postoperative mortality, time of hospitalisation and time of ICU stay between the two groups.ConclusionsDelta-shaped anastomosis may be an effective alternative method for gastroesophageal anastomosis after esophagectomy, with lower incidence of leakage and stenosis.

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Section: Discussionmentioning

confidence: 99%

A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy

Huang

Zhuang

et al. 2017

World J Surg Onc

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“…They have shown better performance for the linear anastomosis [23,24], but this lower rate of anastomotic stricture seemed to be gauged by a higher anastomotic diameter in the linear arms of those studies rather than the superiority of linear method over circular one. For example, Xu et al compared a group of 166 patients who underwent esophagogastrostomy with the linear stapled method with 68 subjects who underwent the same surgery with the circular stapled technique and demonstrated a significantly higher rate of anastomotic stricture in the circular stapled group compared with the other linear stapled group (20.9% vs 1.9%; P < 0.001) [24]. This could be related to a significantly higher mean diameter of the anastomotic orifice in the linear group compared with the circular arm (1.6 vs 1.0 cm).…”

Section: Discussionmentioning

confidence: 99%

The effect of disc-shaped gastric resection of anastomosis site on reducing postoperative dysphagia and stricture after esophagogastric anastomosis in patients with esophageal cancer

Mahmodlou

Shateri

Homayooni

et al. 2016

Gastroenterology Report

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Background: Esophagectomy remains the most reliable technique for managing esophageal cancer, but anastomotic complications including postoperative leak, ischemia and stricture negatively affect outcomes of this specific surgery. The aim of this study was to evaluate the effects of a novel method of esophagogastric anastomosis for reducing postoperative dysphagia and stricture formation.Methods: Eighty patients who were scheduled for esophagectomy due to esophageal cancer were randomly assigned into two groups: intervention and control (40 each). In the control group, the esophagogastric anastomosis was performed with a linear gastric incision, whilst in the intervention group a new method of disc-shaped gastric resection for anastomosis was applied. Postoperative outcomes were compared between the two groups.Results: The incidence of postoperative dysphagia and anastomotic stricture was significantly lower in the disc-shaped resection group (dysphagia 45% vs 75%, P = 0.02; stricture 12.5% vs 32.5%, P = 0.03), whilst the length of stay in an intensive care unit (ICU), anastomotic leakage and other complications were not significantly different between the two groups (all P > 0.05).Conclusion: Anastomotic complications can be reduced by improving surgical techniques. The decreased incidence of postoperative dysphagia and anastomotic stricture in our study may be partly due to providing the proper diameter for the site of anastomosis when using the disc-shaped gastric resection method. Hence, this new method can improve the clinical outcomes of patients who undergo esophagectomy with esophagogastric anastomosis.

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“…The procedure should be as fast as possible, with the least tissue trauma and quick restoring function, and, consequently, minimization of the possibility of postoperative complications. 1,2 It was only in the late 19th century, however, that gastrointestinal sutures became reliable, due to an acquired knowledge of the principles of …”

Section: Introductionmentioning

confidence: 99%

“…The cost of using a stapler is high, and its indication should be based on the real advantages of its use. 2,3,10 It is of great importance to the final outcome of sutures, be they done manually or mechanically, to take care in all processes, such as with hemostasis, dissection and suitable preparation of the edges to be sutured, blood supply, and lack of tension in the suture line. 10,11 Accordingly, the literature has proven that there are no substantial differences in the end results of manual sutures and those made by staplers.…”

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confidence: 99%

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Randomized clinical trial comparing manual suture and different models of mechanical suture in the mimicking of bariatric surgery in swine

Batista¹,

Fernandes²,

Pereira³

et al. 2014

OAS

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Context and objective:Variations in the ability of surgeons served as motivation for the development of devices that, overcoming individual differences, allow the techniques to be properly performed, and of which the end result was the best possible. Every technique must be reproduced reliably by the majority of surgeons for their results to be adopted and recognized as effective. The aim of this study was to compare the results, from the point of view of anatomic pathology, of manual sutures versus mechanical sutures using different models of linear mechanical staplers, in the procedure of gastroenteroanastomosis and enteroanastomosis in swine. Methods: Thirty-six healthy, adult, male Sus scrofa domesticus pigs, weighing between 20.7 and 25.5 kg, were used. The swine were randomly divided into four groups of nine pigs, according to the type of suture employed: group A, manual suture with Polysorb the seventh postoperative day for histopathological analysis, and the degree of inflammation, fibrosis, and newly formed vessels, as well as the presence or absence of granulation tissue, foreign body granuloma, and necrosis were all evaluated qualitatively and semiquantitatively. The results were analyzed statistically. Results:Observations during the histopathological analysis included the formation of foreign body granuloma in the gastroenteroanastomosis and enteroanastomosis in 88.9% of the swine that underwent manual suture and in none of the swine that underwent stapling. There was also a significant statistical difference among swine from Group A, and those from groups B, C and D regarding the degree of inflammation, being more intense in those swine that underwent manual suture. Conclusion: This study shows that both types of suture promoted proper healing of gastroenteroanastomosis and enteroanastomosis, although there was a higher degree of inflammation and an increased occurrence of foreign body granuloma in swine subjected to manual suture, although there have been similarities in safety, efficiency, and effectiveness between the models of linear mechanical staplers tested during the performance of these anastomoses on swine.

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Linear Stapled Esophagogastrostomy is more Effective than Hand-Sewn or Circular Stapler in Prevention of Anastomotic Stricture: a Comparative Clinical Study

Abstract: The linear stapled esophagogastrostomy could decrease anastomotic stricture without increasing gastroesophageal reflux.

Cited by 51 publications

References 24 publications

A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy

A comparison of cervical delta-shaped anastomosis and circular stapled anastomosis after esophagectomy

The effect of disc-shaped gastric resection of anastomosis site on reducing postoperative dysphagia and stricture after esophagogastric anastomosis in patients with esophageal cancer

Randomized clinical trial comparing manual suture and different models of mechanical suture in the mimicking of bariatric surgery in swine

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