Duodenal closure and esophagojejunostomy experience with mechanical stapling devices in total gastrectomy for cancer

Two hundred fifty patients with cancer underwent gastrectomy over a ten-year period. In 225 the duodenum was closed by stapler and only one disruption occurred (0.45%). The first 89 esophagojejunostomies were hand sewn, and thereafter 161 were stapled with an end-to-end anastomosis device. Overall mortality was 27% and 10%, respectively. Death due to surgical causes occurred in 19% of the cases in the first group and 6.8% in the second. No statistical difference was observed in the esophageal anastomosis leakage rate, but the mortality due to such fistula was significantly higher in the group of hand-sewn anastomoses. Surprisingly, esophageal end invasion (at the anastomotic site) was 14% in the manual group vs 3.9% in the stapled one. The operator's experience had no effect on the incidence of esophageal fistula when the stapler was used. Thus, staplers are safe and useful when total gastrectomy is undertaken, provided that sound experience has been acquired.