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Three years' experience with esophageal stapling device.

P R Behl, M P Holden, A H Brown

    Annals of Surgery
    |August 1, 1983
    PubMed
    Summary
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    This study on esophageal cancer surgery found that using an end-to-end anastomosis (EEA) stapler reduced operating time and anastomotic leaks. While some complications occurred, the EEA stapler is recommended for safer esophageal and stomach resections.

    Area of Science:

    • Gastroenterology
    • Surgical Oncology
    • Thoracic Surgery

    Background:

    • Esophageal and proximal stomach carcinomas require surgical resection with anastomosis.
    • Traditional anastomosis techniques can be associated with complications such as leaks and strictures.
    • The end-to-end anastomosis (EEA) stapler offers a potentially improved method for creating these connections.

    Purpose of the Study:

    • To evaluate the safety and efficacy of using an end-to-end anastomosis (EEA) stapler in patients undergoing resection of middle and lower thirds of the esophagus or proximal stomach.
    • To assess the incidence of anastomotic leaks, postoperative complications, and long-term stricture formation associated with EEA stapler use.

    Main Methods:

    • Retrospective review of forty patients who underwent esophagogastric or esophagojejunal anastomosis using an EEA stapler.

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  • Analysis of operative time, blood loss, anastomotic leak rates, early postoperative mortality, and long-term complications like fibrotic strictures.

    • Main Results:

    • Two patients experienced fatal anastomotic leaks.
    • Seven patients died from early postoperative respiratory and cardiovascular complications.
    • Four patients developed fibrotic strictures within 6-24 months, which were successfully dilated and did not recur.
    • The EEA stapler was associated with reduced operating time and likely decreased blood loss.

    Conclusions:

    • The EEA stapler is recommended for esophageal and proximal stomach resections due to reduced operating time and anastomotic leak incidence.
    • The majority of anastomoses can be performed via a left thoracic approach using the EEA stapler.
    • While complications were noted, the benefits of the EEA stapler in reducing operative time and leaks support its continued use.