• Benign
• Esophagectomy
• Stenosis
• Stricture

• Anastomotic leak
• Anastomotic techniques
• Oesophageal cancer surgery
• Oesophagectomy
• Surgical oncology

• Humans
• Esophageal Neoplasms/surgery
• Anastomosis, Surgical/methods
• Randomized Controlled Trials as Topic
• Esophagectomy/methods
• Surgical Stapling/methods
• Stomach/surgery
• Esophagus/surgery
• Anastomotic Leak/prevention & control
• Anastomotic Leak/epidemiology

• conduit
• esophagectomy
• esophagogastric anastomosis
• minimally invasive esophagectomy

• Anastomosis
• Esophageal Surgery
• Esophagectomy
• Esophagogastric
• Meta-Analysis

• Humans
• Esophagectomy/adverse effects
• Esophagectomy/methods
• Anastomotic Leak/epidemiology
• Retrospective Studies
• Constriction, Pathologic/etiology
• Constriction, Pathologic/surgery
• Constriction, Pathologic/epidemiology
• Esophagitis, Peptic/surgery
• Bayes Theorem
• Surgical Stapling/adverse effects
• Esophageal Neoplasms/surgery
• Esophageal Neoplasms/complications
• Treatment Outcome
• Anastomosis, Surgical/adverse effects
• Anastomosis, Surgical/methods
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery

• Circular stapler
• Esophagogastric tube anastomosis
• Hybrid anastomosis
• Postoperative complication

• Humans
• Esophageal Neoplasms/surgery
• Esophagectomy/methods
• Constriction, Pathologic/surgery
• Esophageal Squamous Cell Carcinoma/surgery
• Anastomosis, Surgical/methods
• Surgical Stapling/adverse effects

• Anastomotic leak
• Esophagectomy
• Fibrin glue
• Polyglycolic acid sheets

• Anastomotic Leak/etiology
• Anastomotic Leak/surgery
• Esophageal Neoplasms/surgery
• Fibrin Tissue Adhesive/therapeutic use
• Humans
• Polyglycolic Acid/therapeutic use
• Retrospective Studies
• Tissue Adhesives/therapeutic use

Owing to varying clinical definitions of anastomotic stricture following esophageal reconstruction, its reported incidence rate varies from 10% to 56%. Strictures adversely impact patients’ quality of life. Risk factors, such as the anastomosis method, leakage, ischemia, neoadjuvant chemoradiotherapy, and underlying disease have been mentioned, but conflicting information has been reported. Balloon dilation is regarded as a safe and effective treatment method for patients with benign anastomotic strictures. Reoperations are seldom required. The etiology and management of anastomotic strictures are reviewed in this article.

• Anastomosis
• Esophageal stenosis
• Esophagectomy

• Anastomotic leak
• Anastomotic stricture
• Linear stapled anastomosis
• Oesophageal surgery
• Semimechanical anastomosis

Controversies in terms of efficacy and postoperative advantages surround stapled esophagogastric anastomosis compared with the hand-sewn technique as a treatment for patients with esophageal cancer. The purpose of this study was to compare the clinical outcomes of hand-sewn end-to-side esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis after esophagectomy for the aforementioned patients.

This retrospective cohort study involved examining the medical records of 433 patients who underwent transhiatal esophagectomy for esophageal cancer from March 2010 to March 2016. All the patients were operated using end-to-side hand-sewn esophago-gastrostomy and side-to-side stapled cervical esophagogastric anastomosis. 409 of the patients received a year’s worth of follow-up evaluations. All the cases were revisited in 2 weeks as well as in four, eight, and 12 months after surgery. The patients were assessed in terms of postoperative outcomes, including reflux symptoms, anastomotic leakage and stricture, and the need for anastomotic dilatation.

Hand-sewn anastomosis was carried out in 271 (62.5%) patients, whereas stapled anastomosis was performed in 162 (37.4%) patients. The mean operative times were 214.46 ± 84.33 min and 250.55 ± 43.31 min for the stapled and hand-sewn anastomosis groups, respectively (P = 0.028). The two groups showed no significant differences with respect to stays in intensive care units and hospitals. Postoperatively, 38 (14.67%) cases of anastomotic leakage were detected in the hand-sewn anastomosis group, with incidence being significantly higher than that in the stapled anastomosis group (8 cases or 5.33%; P = 0.002). Anastomotic stricture occurred less frequently in the patients who underwent stapled anastomosis (P = 0.004). Within the one-year follow-up period, the patients treated via hand-sewn anastomosis more frequently required anastomotic dilatation (P = 0.02).

Side-to-side stapled cervical esophagogastric anastomosis may reduce operation times and decrease the rates of anastomotic leakage, anastomotic stricture, and anastomotic dilatation in patients with lower thoracic esophageal cancer undergoing transhiatal esophagectomy.

• Anastomotic leakage
• Anastomotic stricture
• End-to-side hand-sewn anastomosis
• Esophageal cancer
• Side-to-side stapled cervical esophagogastric anastomosis

• benign anastomotic stricture
• esophageal cancer
• gastric conduit

Cervical anastomotic leakage remains a great challenge for thoracic surgeons in the surgical treatment of esophageal cancer. Among the factors affecting cervical anastomosis healing, the surgical technique is the key controllable element. This study aimed to identify the risk factors of cervical anastomotic leakage after McKeown esophagectomy, especially those controllable surgical factors.

A retrospective review of patients who underwent McKeown esophagectomy in the past eight years in West China Hospital was performed. Patients with cervical anastomotic leakage were assigned to leakage group (LG) while the left was enrolled in the none-leakage group (NLG). Multivariate logistic regression analysis was used to identify independent risk factors of anastomotic leakage.

A total of 518 patients were enrolled in the final analysis. In the baseline comparison, the difference in fixation of anastomosis in the neck, anastomosis mode, diabetes, and hypertension between the LG and NLG reached statistically significant. Moreover, the statistical difference of cervical fixation, anastomosis mode, and hypertension remained significant in the multivariate logistic regression analysis.

The cervical anastomosis fixation, anastomosis mode, and hypertension are independent risk factors of gastroesophageal cervical anastomotic leakage.

• Cervical anastomotic leakage
• cervical anastomosis fixation
• esophagectomy
• risk factor

Current evidence on the benefits of different anastomotic techniques (hand‐sewn (HS), circular stapled (CS), triangulating stapled (TS) or linear stapled/semimechanical (LSSM) techniques) after oesophagectomy is conflicting. The aim of this study was to evaluate the evidence for the techniques for oesophagogastric anastomosis and their impact on perioperative outcomes.

This was a systematic review and network meta‐analysis. PubMed, EMBASE and Cochrane Library databases were searched systematically for randomized and non‐randomized studies reporting techniques for the oesophagogastric anastomosis. Network meta‐analysis of postoperative anastomotic leaks and strictures was performed.

Of 4192 articles screened, 15 randomized and 22 non‐randomized studies comprising 8618 patients were included. LSSM (odds ratio (OR) 0·50, 95 per cent c.i. 0·33 to 0·74; P = 0·001) and CS (OR 0·68, 0·48 to 0·95; P = 0·027) anastomoses were associated with lower anastomotic leak rates than HS anastomoses. LSSM anastomoses were associated with lower stricture rates than HS anastomoses (OR 0·32, 0·19 to 0·54; P < 0·001).

LSSM anastomoses after oesophagectomy are superior with regard to anastomotic leak and stricture rates.

• complication
• esophageal cancer
• esophagectomy
• risk factor

• esophageal achalasia
• anastomosis, surgical
• suture techniques
• acalásia esofágica
• anastomose cirúrgica
• técnicas de sutura

• Adult
• Anastomosis, Surgical
• Endoscopic Mucosal Resection
• Esophageal Achalasia/surgery
• Esophagectomy
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies
• Severity of Illness Index
• Suture Techniques
• Treatment Outcome
• Young Adult

The present standard of surgical treatment for esophageal cancer is country dependent. The aim of the present study was to investigate the basic aspects of surgical procedures performed for esophageal cancer, and provide information about the present state of esophageal cancer surgery in China.

Data were obtained from a database administered by the Chinese Ministry for Health. A total of 542 participating hospitals were divided into seven geographic areas, and 10% of hospitals in each area were randomly chosen for inclusion. All patients with esophageal cancer, who underwent esophagectomy in these participating hospitals from January 1 to December 31, 2015, were included in the present study. The clinical characteristics, stage of tumor at diagnosis, operation summary and outcomes, and histological findings of patients were extracted and analyzed.

The present study included 11,791 patients, and the average number of patients per hospital was 218. Squamous cell carcinoma was the most common pathological type, while the mid-esophagus was the most common location. Open procedures were performed in 63.8% of patients, while minimally invasive esophagectomy was performed in 36.2% of patients. Multiple approaches to transthoracic esophagectomy were utilized. Two-field lymphadenectomy was the most frequently performed (64.8%), followed by three-field lymphadenectomy (21.8%). Gastric tubes, thoracic duct ligation and postoperative enteral nutrition were implemented to minimize complications.

The standard operative procedure and detailed technique for esophageal carcinoma surgery is presently being debated in China. This survey provides some basic information about the present state of esophageal cancer surgery countrywide.

• China
• Database
• Esophageal cancer
• Surgery

• anastomosis
• esophageal cancer
• hand-sewn
• mechanical staples
• meta-analysis
• systematic review

• Anastomosis, Surgical/methods
• Esophageal Neoplasms/surgery
• Esophagus/surgery
• Female
• Humans
• Male
• Meta-Analysis as Topic
• Research Design
• Stomach/surgery
• Surgical Stapling/methods
• Surgical Stapling/statistics & numerical data
• Suture Techniques/statistics & numerical data
• Systematic Reviews as Topic
• Treatment Outcome

• anastomotic leak
• cost
• esophagectomy
• resources

• Esophageal cancer
• anastomotic leak (AL)
• neoadjuvant chemoradiotherapy (NCR)

LigaSure® Small Jaw (LSJ) has been recently introduced as an energy-based vessel sealing device, which has provided better intraoperative and postoperative outcomes in thyroidectomies, compared to conventional technique. In the current study, we aimed to examine the efficiency of hand-sewn and LSJ thyroidectomy, based on operation time and perioperative complications.

All patients with the diagnosis of multinodular goiter, thyroid cancers, retrosternal goiter and other indications for thyroid surgeries, enrolled. Of 550 patients, 261 patients randomly assigned to the conventional group (A) and 274 patients to LigaSure Small Jaw group (B). Study groups compared concerning operative time, recurrent laryngeal nerve (RLN) injury, hypocalcemia, and postoperative complications.

There was no significant difference regarding demographic data between groups A and B. During total thyroidectomy, intraoperative blood loss was 64.42 ± 20.72 ml and 49.64 ± 17.92 ml in groups A and B, respectively (P 0.043). Operative time was significantly lower in LSJ group compared to the conventional group in total and subtotal thyroidectomy (P 0.002; P 0.001). Three patients who underwent conventional total thyroidectomy had RLN palsy. However, there was no significant difference between techniques regarding RLN injury (P 0.134).

Postoperative total and ionized serum calcium levels decreased compared to preoperative levels in both conventional and LSJ technique; however, changes in total and ionized serum calcium were more severe in patients with conventional thyroidectomy (total calcium, P < 0.0001) (ionized calcium, P 0.005).

The LigaSure Small Jaw device decreases operative time and intraoperative bleeding compared to conventional technique. Besides, changes in total and ionized calcium levels in patients with LSJ thyroidectomy are subtle compared to HS technique.

Registered in Iranian Registry of Clinical Trials (www.irct.com), trial registration: IRCT2014010516077N1, Registered: 23 May 2014).

• Conventional
• Hypocalcemia
• LigaSure® Small Jaw
• Recurrent laryngeal nerve
• Thyroidectomy

• Completely stapled cervical anastomosis
• Linear stapled esophagogastric anastomosis
• Mechanical cervical esophagogastric anastomosis
• Stapled esophagogastric anastomosis

• esophageal cancer
• esophagectomy
• hand-sewn anastomosis

• mechanical anastomosis
• mediastinal infections
• oesophagogastric anastomosis
• oesophagus cancer
• surgical treatment

• Hand sewn anastomosis
• cervical esophagogastric anastomosis (CEGA)
• end-to-end anastomosis
• esophageal squamous cell carcinoma (ESCC)
• esophagectomy

Surgery is the treatment of choice for squamous cell esophageal cancer. Complete resection of the esophagus with reconstruction of the digestive tract is performed for tumors located in the chest or cardia. The aim of the report is to present the case of a complete esophageal and gastric resection complicated by colon graft necrosis. The patient was a 45-year-old woman diagnosed with cancer of the cardia infiltrating the distal section of the esophagus and the body and fundus of the stomach. The initial surgical procedure included the opening of three body cavities followed by resection of the thoracic esophagus, stomach, and a portion of the left hepatic lobe. Right colon interposition was performed to restore digestive tract continuity. On the 8th day, a leak was observed in the esophagointestinal anastomosis. Management consisted in two surgical procedures, one of which ended in the removal of the colon patch. The fourth and final procedure was conducted after 10 months.

• complications
• esophageal cancer
• esophageal resection

• Cervical anastomosis
• Circular stapler
• Esophagectomy
• Hand-sewn
• Meta-analysis
• Systematic review

• Low-volume center
• morbidity
• survival transhiatal esophagectomy

AIM: To compare the outcome of hand sewing and stapling for anastomotic leakage after esophagectomy.

METHODS: A rigorous study protocol was established according to the recommendations of the Cochrane Collaboration. An electronic database search, hand search, and reference search were used to retrieve all randomized controlled trials that compared hand-sewn and mechanical esophagogastric anastomoses.

RESULTS: This study included 15 randomized controlled trials with a total of 2337 patients. The results revealed that there was no significant difference in the incidence of anastomotic leakage between the methods [relative risk (RR) = 0.77, 95% confidence interval (CI): 0.57-1.04; P = 0.09], but a subgroup analysis yielded a significant difference for the sutured layer and year of publication (Ps < 0.05). There was also no significant difference in the incidence of postoperative mortality (RR = 1.52, 95%CI: 0.97-2.40; P = 0.07). However, the anastomotic strictures rate was increased in the stapler group compared with the hand-sewn group (RR = 1.45, 95%CI: 1.11-1.91; P < 0.01) in the end-to-side subgroup, while the incidence of anastomotic strictures was decreased (RR = 0.34, 95%CI: 0.16-0.76; P < 0.01) in the side-to-side subgroup.

CONCLUSION: The stapler reduces the anastomotic leakage rate compared with hand sewing. End-to-side stapling increases the risk of anastomotic strictures, but side-to-side stapling decreases the risk.

• Anastomotic leakage
• Esophagectomy
• Hand-sewn sutures
• Mechanical sutures
• Meta-analysis

• Anastomotic Leak/diagnosis
• Anastomotic Leak/epidemiology
• Anastomotic Leak/prevention & control
• Chi-Square Distribution
• Esophagectomy/adverse effects
• Humans
• Incidence
• Odds Ratio
• Risk Factors
• Surgical Stapling/adverse effects
• Suture Techniques/adverse effects
• Treatment Outcome

Free jejunal interposition is a useful technique for reconstruction of the cervical esophagus. However, the distal anastomosis between the graft and the remaining thoracic esophagus or a gastric conduit can be technically challenging when located very low in the thoracic aperture. We here describe a modified technique for retrograde stapling of a jejunal graft to a failed gastric conduit using a circular stapler on a delivery system.

A 56 year-old patient had been referred for esophageal squamous cell carcinoma at 20 cm from the incisors. On day 8 after thoracoabdominal esophagectomy with gastric pull-up, an anastomotic leakage was diagnosed. A proximal-release stent was successfully placed by gastroscopy and the patient was discharged. Two weeks later, an esophagotracheal fistula occurred proximal to the esophageal stent. Cervical esophagostomy was performed with cranial closure of the gastric conduit, which was left in situ within the right hemithorax. Three months later, reconstruction was performed using a free jejunal interposition. The anvil of a circular stapler (Orvil®, Covidien) was placed transabdominally through an endoscopic rendez-vous procedure into the gastric conduit. A free jejunal graft was retrogradely stapled to the proximal end of the conduit. Microvascular anastomoses were performed subsequently. The proximal anastomosis of the conduit was completed manually after reperfusion.

This modified technique allows stapling of a jejunal interposition graft located deep in the thoracic aperture and is therefore a useful method that may help to avoid reconstruction by colonic pull-up and thoracotomy.

Surgery for digestive tract disease predominantly consists of reconstruction and anastomosis. Due to the difficult location, anastomosis is extremely challenging and the risk of complication increases accordingly. Traditional manual anastomosis and the application of a stapling device are insufficient. Therefore, the aim of this study was to investigate the feasibility and safety of a novel manual method in a difficult anastomotic location, consisting of a single-layer continuous suture in the posterior wall. In total, 15 beagle dogs were included in the study; eight underwent surgery with the novel manual method for reconstruction and anastomosis of the digestive tract, while seven underwent surgery with the stapler device as a control. The subsequent postoperative complications were observed and, three months later, the anastomotic ports were excised, and the pathological formation and morphological changes were evaluated. No statistically significant differences were identified between the total (50.0 vs. 57.1%; P=0.782) and anastomotic (0.0 vs. 28.6%; P=0.200) complication rates in the manual suture and staple suture groups, respectively. Compared with the control group, the operative expenditure was lower in the manual group (1726.7±33.5 vs. 2135.7±43.1 renminbi; P=0.001), the diameter of the anastomotic port was larger in the manual group (3.04±0.07 vs. 2.24±0.25 cm; P=0.004) and the thickness of the anastomotic port (in cm) was thinner in the manual group (2.94±0.06 vs. 5.07±0.85; P=0.002). Furthermore, the pathological formation of the anastomositic port in the manual group was improved. The results of the current study suggest single-layer continuous suture of the posterior wall in anastomosis of the digestive tract to be a novel method with feasibility and safety, particularly in difficult anastomotic locations.

• anastomosis
• complication
• digestive tract
• single-layer
• suture

• Aged
• Anastomosis, Surgical/adverse effects
• Anastomotic Leak/diagnostic imaging
• Anastomotic Leak/etiology
• Anastomotic Leak/prevention & control
• Carcinoma/surgery
• Eating
• Esophageal Achalasia/surgery
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Esophagus/surgery
• Female
• Humans
• Length of Stay
• Male
• Middle Aged
• Patient Care Planning
• Postoperative Care
• Radiography
• Retrospective Studies
• Stomach/surgery
• Time Factors

• anastomosis
• esophageal replacement
• esophageal substitution
• esophagectomy

• Humans
• Anastomosis, Surgical
• Anastomotic Leak/etiology
• Esophageal Neoplasms/complications
• Esophageal Neoplasms/surgery
• Esophagectomy/adverse effects
• Postoperative Complications
• Treatment Outcome

Cervical esophagogastrostomy is currently the most common method for esophageal reconstruction after esophagectomy. The advantages and disadvantages of hand-sewn, linear-stapled, or circular-stapled anastomoses have been subject to debate in recent years. We explored a new method of end-to-side anastomosis using a circular stapler that embeds the anastomosis and the remaining esophageal tissue into the gastric cavity to reduce the occurrence of anastomotic leakage and to prevent gastroesophageal reflux.

In 127 patients with esophageal carcinomas, end-to-side anastomoses with esophageal embedding were performed by connecting the anvil and body of the circular stapler inside the stomach before firing and embedding the anastomosis and remaining esophagus into the stomach after esophagectomy. Retrospective investigations on postoperative complications such as leakage, stricture, and gastroesophageal reflux were conducted.

A total of 123 patients (96.9 %) had successful surgery, and 4 patients (3.3 %) developed anastomotic leakage, with the total morbidity of 20 of 123 (16.3 %) and in-hospital mortality of 1 of 123 (0.8 %). The incidence of stricture (<1 cm) affected 14 of 123 patients (11.4 %). Eight patients underwent dilatation treatment as a result of severe dysphagia (6.5 %). Half of the patients [62 of 123 (50.4 %)] experienced postoperative heartburn, 11 of 123 patients (8.9 %) experienced acid regurgitation, and 16 of 123 patients (13.0 %) experienced nocturnal cough.

Embedded cervical esophagogastrostomy with circular stapler is a simple and convenient method, with low incidence of anastomotic leakage and a good antireflux effect.

The aim of this study was to analyze the early postoperative outcome of esophageal cancer treated by subtotal esophageal resection, gastric interposition and either intrathoracic or cervical anastomosis in a single center study.

72 patients who received either a cervical or intrathoracic anastomosis after esophageal resection for esophageal cancer were matched by age and tumor stage. Collected data from these patients were analyzed retrospectively regarding morbidity and mortality rates.

Anastomotic leakage rate was significantly lower in the intrathoracic anastomosis group than in the cervical anastomosis group (4 of 36 patients (11%) vs. 11 of 36 patients (31%); p = 0.040). The hospital stay was significantly shorter in the intrathoracic anastomosis group compared to the cervical anastomosis group (14 (range 10–110) vs. 26 days (range 12 – 105); p = 0.012). Wound infection and temporary paresis of the recurrent laryngeal nerve occurred significantly more often in the cervical anastomosis group compared to the intrathoracic anastomosis group (28% vs. 0%; p = 0.002 and 11% vs. 0%; p = 0.046). The overall In-hospital mortality rate was 6% (4 of 72 patients) without any differences between the study groups.

The present data support the assumption that the transthoracic approach with an intrathoracic anastomosis compared to a cervical esophagogastrostomy is the safer and more beneficial procedure in patients with carcinoma of the lower and middle third of the esophagus due to a significant reduction of anastomotic leakage, wound infection, paresis of the recurrent laryngeal nerve and shorter hospital stay.