Article Abstract

Modified technique for cervical esophagogastric anastomosis by circular stapler after priority attachment of the anvil in the narrow neck region

Authors: Hiroshi Makino, Hiroshi Maruyama, Tadashi Yokoyama, Atsushi Hirakata, Yuta Kikuchi, Takuma Iwai, Masafumi Yoshioka, Jyunji Ueda, Hideyuki Takata, Hiroshi Yoshida


Background: Surgical resection is a critical element in the treatment of esophageal cancer. Minimally invasive esophagectomy (MIE) has the potential to reduce morbidity and mortality in esophageal cancer surgery. Among postoperative complications after esophagectomy, anastomotic leakage is the greatest concern. Since anastomosis is performed at the end of a long esophageal cancer resection surgery, a simple anastomosis method which can be completed quickly and safely is desired.
Methods: A CDH trocar inserted to the gastric tube is attached to the anvil head and the head is inserted into the esophagus. Anastomosis of the stomach to the cervical esophagus is performed using a circular stapler (CS) after priority attachment of the anvil.
Results: Anastomotic leakage and postoperative stenosis were observed in approx. 5% of cases. Stable circular stapled anastomosis using this method is possible, regardless of the length of the gastric tube.
Conclusions: Consequently, we performed circular stapled anastomosis using a CS. Moreover, we perform cervical anastomosis even for arthroscopy or thoracotomy since direct vision is possible, and this method is safe even in cases where problems in suturing occur.