Comparison of manual and mechanical cervical esophagogastric anastomosis after Esophageal Resection.

INTRODUCTION : Esophagectomy is increasingly performed for a wide spectrum of conditions but mostly for carcinoma. Improvement of perioperative management and surgical techniques has resulted in a steady decrease in postoperative mortality. Today, postoperative hospital mortality in centers with experience is well below 5%. Overall 5-year survival rates as high as 30–40% have been reported after resection with curative intent. As a result, an increasing number of patients are now surviving on a long-term basis. Their quality of life may be very much influenced by the quality of their esophageal anastomosis. Furthermore, despite all efforts, in a majority of the patients surgery remains palliative mainly because of the unexpected advanced stage of the disease at the time of surgery. In such patients, quality of palliation is of paramount importance. It is widely accepted that surgery offers the best form of palliation but the quality of palliation may still be jeopardized by anastomotic complications, i.e. anastomotic leak or even worse, catastrophic complications such as the necrosis of the proximal part of the conduit used for reconstruction or in a late stage anastomotic stricture formation. The organ most used for reconstruction after esophagectomy is the stomach. Advantages include ease of construction and the prospect to achieve a substitute of sufficient length.This study was designed to compare two methods of esophagogastric anastomosis, one with hand-sewn anastomosis and the other with mechanical stapled anastomosis. AIM : The objectives of the study are 1. To compare the rates of anastomotic leaks after cervical esophago gastric anastomosis (CEGA) done by hand-sewn (end-to-side) technique or by linear stapled anastomosis (side-to-side) technique. 2. To compare the rates of postoperative anastomotic stricture after cervical esophago gastric anastomosis (CEGA) done by hand-sewn (end-to-side) technique or by linear stapled anastomosis (side-to-side) technique. CONCLUSION : Construction of the cervical esophagogastric anastomosis with a side-to-side stapled anastomosis greatly reduces the frequency of anastomotic leaks and later strictures rates. The side-to-side stapled anastomosis is a major technical advance in the progression of refinements of transhiatal esophagectomy and a cervical esophagogastric anastomosis. Transhiatal esophagectomy is feasible in most patients requiring esophageal resection for malignant disease and is a safe, well-tolerated operation if performed with care and for the proper indications. The semimechanical technique for cervical esophagogastrostomy is associated with a shorter postoperative stay