Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy

Area of Science:

• Surgical techniques in gastrointestinal reconstruction
• Minimally invasive surgical procedures
• Esophageal and gastric surgery outcomes

Background:

• The traditional manual end-to-side esophagogastrostomy after gastric pull-up to the neck has a high incidence of complications, including fistula and stricture.
• Need for improved surgical techniques to reduce morbidity associated with esophagogastrostomy.

Purpose of the Study:

• To evaluate a novel terminalized semimechanical side-to-side technique for cervical esophagogastrostomy.
• To compare the anastomotic area and outcomes of the semimechanical technique with the classic manual end-to-side method.

Main Methods:

• Sixteen patients underwent cervical esophagogastrostomy using a semimechanical side-to-side technique with an Endo-GIA stapler.
• A V-shaped opening was created between gastric and esophageal walls, with the anterior aspect hand-sewn.
• Cross-sectional anastomotic area was assessed via barium swallow study at 2 months and compared to 24 manual esophagogastrostomies.

Main Results:

• Semimechanical anastomoses had a significantly larger cross-sectional area (225 mm²) compared to manual anastomoses (136 mm²) (p=0.0001).
• Anastomotic area correlated with dysphagia severity, with larger areas in patients without dysphagia.
• Transient narrowing was observed in some cases, but moderate dysphagia resolved spontaneously in most patients.

Conclusions:

• The terminalized semimechanical side-to-side suture technique results in a significantly larger cervical esophagogastrostomy compared to the manual end-to-side method.
• This technique may reduce the risk of complications like stricture and improve patient outcomes.
• Transient anastomotic narrowing due to inflammatory changes is possible but often resolves.