Introduction Minimally-invasive oesophagectomy (MIO) is an increasingly popular strategy for oesophageal cancer resection in appropriately selected patients. In three-stage procedures, the oesophagus and stomach are mobilised thoracoscopically and laparoscopically, with a mini-laparotomy for conduit formation and specimen removal. The conduit is then delivered into the neck for construction of the oesophagogastric anastomosis. Traditionally the anastomosis is either entirely hand-sewn, or is semi-mechanical. Here, we discuss the use of fully mechanical anastomosis using a circular stapler (CS) in selected patients and report the clinical details, early outcomes.
Method Patients undergoing MIO at our centre from November 2014 were considered for CS anastomosis using a gastrointestinal circular stapler (Ethicon™, UK). The clinical conditions necessary for use of CS were assessed at the time of surgery, the primary criterion being the availability of a sufficiently long conduit. All patients receiving a successful fully mechanical anastomosis are included.
Results Four patients underwent CS anastomosis. Age range was 58–79 and included 2 male and 2 female patients. The first case had an area of proximal Barrett’s dysplasia which would have required a high hand sewn anastomosis. Another patient had very significant comorbid factors including rheumatoid arthritis and long-term corticosteroid and methotrexate use. In all of these cases, the anastomosis was successfully formed on first attempt. No early leaks occurred.
Conclusion Use of CS is described for minimally invasive two phase and open oesophagectomy, and is occasionally reported for three-stage MIO. The majority of surgeons use the either fully hand-sewn or partially mechanical techniques for cervical anastomoses. We describe a simple technique for a stapled neck anastomosis which is faster to construct and enables a more proximal oesophageal resection without difficulty.
Disclosure of interest None Declared.
Price TN, Nichols FC, Harmsen WS, Allen MS, Cassivi SD, Wigle DA, Shen KR, Deschamps C. A comprehensive review of anastomotic technique in 432 esophagectomies. Ann Thorac Surg. 2013;95(4):1154–60
Li J, Shen Y, Tan L, Feng M, Wang H, Xi Y, Leng Y, Wang Q. See comment in PubMed Commons belowCervical triangulating stapled anastomosis: technique and initial experience. J Thorac Dis. 2014;6(3):S350–4
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