Technique of Minimally Invasive Ivor Lewis Esophagogastrectomy with Intrathoracic Stapled Side-to-Side Anastomosis

Ben-David, Kfır; Sarosi, George A.; Cendán, Juan; Hochwald, Steven N.

doi:10.1007/s11605-010-1244-5

Cited by 46 publications

(22 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Esophagectomy using the Ivor Lewis technique has been performed by many authors 26,27 . In this technique, esophagogastric anastomosis is carried out in the apex of the thorax and, besides preserving 5.0 cm more of esophagus compared to cervical anastomosis, is considered a radical surgical technique.…”

Section: Discussionmentioning

confidence: 99%

“…Esophagectomy is a major surgery that has both a high morbidity rate (60%) and mortality rate, which may reach 26.7%, mainly due to pulmonary complications, cervical fistulas, stenosis of anastomosis, necrosis of the tubularized stomach, and mediastinitis 3-6 . Among these possible complications, fistulas of the esophagogastric anastomosis represent one of the main problems of esophagectomies. Incidence in several studies has ranged from 0% to 50%, with most authors reporting a high incidence of this complication 1,4,7,8 . Although these fistulas usually have a favorable course, about 2% of cases can have a catastrophic outcome 6 .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Cervical esophagogastric anastomosis with invagination after esophagectomy

et al. 2012

View full text Add to dashboard Cite

PURPOSE: To evaluate the incidence of fistula and stenosis of the cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach after subtotal esophagectomy. METHODS:We studied 54 patients who underwent subtotal esophagectomy, 45 (83.3%) patients with carcinoma and nine (16.6%) with advanced megaesophagus. In all cases the cervical esophagogastric anastomosis was performed with the invagination of the proximal esophageal stump inside the stomach. RESULTS:Three (5.5%) patients had a fistula at the esophagogastric anastomosis, two of whom with minimal leakage of air or saliva and with mild clinical repercussion; the third had a low output fistula that drained into the pleural space, and this patient developed empyema that showed good progress with drainage. Fibrotic stenosis of anastomosis occurred in thirteen (24%) subjects and was treated successfully with endoscopic dilatation. CONCLUSION:Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula and stenosis, thus becoming an attractive option for the reconstruction of alimentary transit after subtotal esophagectomy. Key words: Esophagus. Esophagectomy. Constriction, Pathologic. Anastomotic Leak, Gastroplasty. RESUMOOBJETIVO: Avaliar a incidência de fístula e estenose da anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago após esofagectomia subtotal. MÉTODOS:Foram estudados 54 pacientes submetidos à esofagectomia subtotal, 45 (83,3%) com carcinoma e nove (16,6%) com megaesôfago chagásico avançado. Em todos os casos, a anastomose esofagogástrica cervical foi realizada com invaginação do coto esofágico proximal no interior do estômago. RESULTADOS:Três (5,5%) pacientes apresentaram fístula, dois deles com saída mínima de ar e saliva pela incisão cervical que evoluíram com rápida cicatrização; o terceiro apresentou fístula de pequeno débito que drenou para o espaço pleural causando empiema que teve boa evolução após drenagem. Treze (24%) doentes apresentaram estenose fibrótica e foram tratados com sucesso com dilatação endoscópica. CONCLUSÃO:A anastomose esofagogástrica cervical com invaginação do coto esofágico proximal no interior do estômago apresentou baixa incidência de fístula e estenose tornando-se opção atraente para a reconstrução do trânsito alimentar após esofagectomia subtotal.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cervical esophagogastric anastomosis with invagination after esophagectomy

et al. 2012

View full text Add to dashboard Cite

show abstract

“…Subsequently, various MIS techniques have been reported in greater detail by others [12][13][14][15]. Although the reported technique for MIE varies, the frequency of this operation remains low nationally due to the technical difficulty of the procedure.…”

Section: Introductionmentioning

confidence: 99%

Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies

et al. 2011

Self Cite

View full text Add to dashboard Cite

show abstract

“…The hybrid side-to-side anastomosis partially needs hand-sewn as well, and a 3-6 cm length of distal esophageal stump is required to create the extended anastomotic orifice, making this technique unsuitable for intrathoracic higher-level anastomosis [2,3]. To our knowledge, circular stapler is currently the primary approach with robot-assisted intrathoracic anastomosis.…”

Section: Discussionmentioning

confidence: 99%

“…Cadiere et al [1] reported that thoracoscopy in the prone position allowed the surgeon to perform a completely hand-sewn thoracoscopic esophagogastric anastomosis. Introduction of the thoracoscopic hybrid side-to-side anastomosis by extension of the posterior esophageal wall, using a linear stapler and anterior hand-sewn closure with 3.5-6 cm length extension, effectively prevented anastomotic stricture [2,3]. When a circular stapler was used to perform thoracoscopic esophagogastric anastomosis, the primary difficulty was with anvil placement in the esophageal lumen.…”

Section: Introductionmentioning

confidence: 99%

Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

et al. 2018

View full text Add to dashboard Cite

Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

show abstract

Technique of Minimally Invasive Ivor Lewis Esophagogastrectomy with Intrathoracic Stapled Side-to-Side Anastomosis

Abstract: A 6-cm side-to-side stapled intrathoracic esophagogastric anastomosis is feasible and is associated with a low anastomotic leak rate.

Cited by 46 publications

References 20 publications

Cervical esophagogastric anastomosis with invagination after esophagectomy

Cervical esophagogastric anastomosis with invagination after esophagectomy

Decreasing morbidity and mortality in 100 consecutive minimally invasive esophagectomies

Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

Contact Info

Product

Resources

About