Reconstruction of the jejunoesophageal anastomosis with a circular mechanical stapler in total laryngopharyngectomy defects

Abstract

Use of circular mechanical stapler appears to be a safe and effective technique at the jejunoesophageal anastomosis for total laryngopharyngeal defects with comparable fistula and stricture rates to grafts that are hand sewn.

Reconstructive Trends in Post-Ablation Patients with Esophagus and Hypopharynx Defect

“…According to certain reports on prevention or minimizing fistula and stricture, novel approaches have been reported to be safe and effective. Examples include gastrointestinal stapler for bowel anastomosis or prophylactic use of a PMMC in patients with history of radiotherapy [ 2 40 42 ].…”

Long‐term surgical and functional outcomes after anterolateral thigh flap and free jejunal transfer reconstruction of circumferential pharyngoesophageal defects

“…All of those studies reported variable outcomes. In our study, the anastomotic stricture rate of the free jejunal transfer group was 5%, and the anastomotic stricture rates after free jejunal transfer reconstruction varied between 2% and 31% 15–19 …”

The Use of a Mechanical Stapler in Jejunal Free Flaps in Laryngopharyngectomy Defects

“…We therefore reviewed the published The presence clinically significant differences in the formation of strictures and fistulae between stapled jejunoesophageal anastomoses and hand-sewn anastomoses remain controversial [5]. However, many authors have concluded that both methods are safe, and in some studies, no significant differences in fistula or stricture formation were observed between stapled and hand-sewn anastomoses [2,3]. In order to minimize the risk of fistula formation, we carefully examined tissue specimens excised using the stapler and inspected the stapled line for hemostasis after flap anastomosis.…”

“…The most common method of securing visceral graft anastomoses was previously one or two layers of hand sewing. However, circular mechanical staplers have been commonly used by general surgeons for enteric anastomosis and lead to similar or lower anastomotic leakage and stricture rates than hand sewing [ 1 2 ]. Stapled anastomoses may also reduce the mean operating time by reducing the time required for anastomosis, and also probably reduce blood loss and the likelihood of intraoperative contamination [ 3 ].…”

“…In particular, during free flap procedures, the mean operative time is critical to the success of surgery, as prolonged operative times increase the intraoperative infection risk and blood loss and can induce perioperative complications and flap injury [ 3 ]. Nevertheless, few studies have described the use of mechanical staplers in the field of plastic and reconstructive surgery, especially in laryngopharyngeal defect reconstruction [ 2 ]. The critical ischemic time varies among different flap types.…”