• Journal of Chest Surgery
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• v.27 no.12
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• pp.1060-1065
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• 1994

For most surgeons, stomach and colon are the first choice for reconstruction of the esophagus, as well as for bypass. When the esophagogastric or esophagocolonic anastomosis is made in the neck, cervical anastomosis site leakage is the main complication. In our most recent four patients who underwent a transhiatal & posterior mediastinal esophagogastric or esophagocolonic anastomoses following esophageal resection, we performed the cervical anastomoses with a circular EEA stapler. No leaks have developed at the anastomosis site. In these four patients the cancer was tiny and was located on the upper or middle third of the thoracic esophagus. A total esophagectomy was performed by blunt resection without thoracotomy. Surgical staplers have been used previously for esophagogastric anastomosis through a right thoracotomy with a very low rate of leakage. When the esophagogastric or esophagocolonic anastomosis is performed in the neck, the prevalence of leakage does not increase the postoperative mortality, but it can increase significantly the duration of hospitalization and morbidity. The use of the circular stapler allowed us to perform four consecutive cervical esophagogastric & esophagocolonic anastomoses without any leakage and to shorten the operating time.

• Korean Journal of Bronchoesophagology
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• v.5 no.2
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• pp.143-152
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• 1999

Background : the technical modality of esophagogastric anastomosis plays an important part in the factors leading to anastomotic leakage and stricture. Objective : The objective of this study was to compare the leakage and stricture rates between the different anastomosis techniques. Materials and Methods : A retrospective study was undertaken in the patients with esophageal cancer who underwent a esophagectomy. Hand-sewn anastomosis was performed in one layer with interrupted sutures(Manual group). The stapler group was divided into two subgroups, such as PCEEA group and Endo-GIA group. Results : The differences of preoperative patient profiles between the groups were not significant. Overall mortality fates were 5% in manual group, 5% in PCEEA group and 11.5% in Endo-GIA group. Fewer anastomotic leakage occurred in manual group(5%) than in PCEEA group(10%) or in Endo-GIA group(15.4%). The postoperative stricture rate was higher in PCEEA group(35%) than in manual group(5%) or in Endo-GIA group(0%) Conclusion : Statistically, there were no significant differences in the anastomotic leakage and stricture rates between the hand-sewn and mechanical anastomosis. But the stricture rate was lower in the group using the linear stapling device and the leakage rate was lower in the hand-sewn group than the other groups.

• Journal of Chest Surgery
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• v.54 no.4
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• pp.286-293
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• 2021

The extracorporeal anastomosis technique for video-assisted thoracoscopic surgery (VATS) intrathoracic esophagogastric anastomosis is a convenient, easy technique to use in VATS esophagectomy. The surgeon can assess the viability and the status of the gastric conduit, and the introduction of a circular stapler can be easily done under direct vision extracorporeally, enabling easy and simple VATS intrathoracic anastomosis between the esophagus and the gastric conduit.

• Journal of Chest Surgery
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• v.23 no.3
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• pp.550-555
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• 1990

Since Steichen and Ravich`s pioneer work in 1972 proved that staples reduced anastomotic leaks and operative time, the use of EEA stapler`s in esophagogastrostomy have gained acceptance and popularity. But overriding these benefits are the high stricture rate, which leads to the reappearance of dysphagia. The mechanism for the development of stricture in stapled anastomosis is likely to be due to the lack of mucosa to mucosa apposition and presence of necrotic tissue between the luminal edge and the rows of the stapler. All strictures were easily dilated. Recently, we encountered a patient who suffered from an esophageal stricture that slowly developed 10 months after an esophagogastric anastomosis with a EEA 425 was performed due to severe muscular hypertrophy of esophagus. Because the stricture failed to respond to the Bougienage, we reoperated using a EEA 28 this time. We feel that this case review helps to show that despite the very low leakage rate in small size EEA stapler, there is also a very high risk of stricture.

• Journal of Gastric Cancer
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• v.22 no.3
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• pp.220-234
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• 2022

Purpose: The incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased in recent years, and the optimal surgical strategy for AEG remains highly controversial. We aimed to evaluate the safety and efficacy of proximal gastrectomy with double-tract reconstruction (PG-DT) for the treatment of patients with AEG. Materials and Methods: We retrospectively analyzed patients with Siewert type II/III AEG between January 2013 and July 2018. Clinicopathological characteristics, survival, surgical outcomes, quality of life (QOL), and nutritional status were compared between the PG-DT and total gastrectomy with Roux-en-Y anastomosis (TG-RY) groups. Results: After propensity score matching, 33 patients in each group were analyzed. There were no statistical differences between the 2 groups in terms of disease-free survival and overall survival. The surgical option was not an independent prognostic factor based on the multivariate analysis. In addition, no differences were found in terms of surgical complications. There were no significant differences in QOL assessed by the Visick grade, Gastrointestinal Symptom Rating Scale, or endoscopic findings. Furthermore, the long-term nutritional advantage of the PG-DT group was significantly greater than that of the TG-RY group. Conclusions: PG-DT is a safe and effective procedure for patients with local Siewert type II/III AEG, regardless of the TNM stage.

• Journal of Chest Surgery
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• v.29 no.9
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• pp.1003-1009
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• 1996

Although esophagogastric (EG) anastomosis with a circular surgical stapler (EEA or ILS) is a safe find convenient proc dure with less anastomotic leakage, a concern for the anastomotic stricture still remains, especially in patients with small esophagus. We modified cervical EG anastomotic technique using straight thoracoscopic endostapler to prevent EG anastomotic stricture. Prospective clinical study was performed to determine the feasibility of our modification using Endo-GIA (US Surgical Corp., Worwalk), during the period from October, 1994 to July, 1995, in thirteen patients with carcinoma of the thoracic esophagus. A stomach tube was reanastomosed to the cervical esophagus utilizing a 30 mm Endo-GIA after esophagectomy and node dissection. There was one early mortality due to respiratory failure and pulmonary tuberculosis. Anastomotic leakage with resultant stricture was noticed in one patient, and it was re- lated to ischemic necrosis of the stomach tube. The overall incidence of stricture was 7.6 % (1113). During the 8 month follow-up period, the remaining 11 patients did not show any clinica evidence of stricture such as dysphagia. All patients were on a regular diet. We conclude that our new technique for cervical EG anastomosis with GIA-Endo stapler is a safe and convenient procedure in preventing anastomotic stricture.

• Journal of Chest Surgery
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• v.23 no.2
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• pp.309-315
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• 1990

The introduction of end-to-end anastomosis stapler [EEA stapler] into esophageal surgery has reduced the mortality and morbidity associated with esophageal resection mainly owing to a reduction in the incidence of accidence of anastomotic leak. We now report the results of the 37 patients undergoing esophagectomy or esophagogastrectomy with EEA stapler in the department of cardiothoracic Surgery, Kosin Medical Center No leakage was demonstrated in the 37 esophagogastric anastomotic sites, but dehiscence of the TA stapled gastrotomy suture line occurred in two patient One patient was recovered with conservative treatment but the other patient was died due to hepatic metastasis of esophageal carcinoma during conservative treatment. And one severe esophagogastric anastomotic stricture was developed at the 30th postoperative day, but improved after dilatation with balloon dilatation catheter of Swiss Med. Tech. Company. The other complications were postoperative pneumonia[1 case], wound disruption and infection[3 cases], but all of 4 patients were recovered with conservative treatment. We experienced relative good postoperative results with use of EEA stapler in esophageal surgery. On the basis of our experience, we believe that the EEA stapler has definite place in esophageal surgery.

• Journal of Gastric Cancer
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• v.17 no.3
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• pp.267-276
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• 2017

Purpose: Different esophagojejunostomy (EJ) reconstruction methods are used after totally laparoscopic total gastrectomy (TLTG), and none is considered a standard technique. This report describes a 2-layer hand-sewn EJ technique during TLTG; we also evaluated postoperative morbidity associated with this technique. Materials and Methods: This retrospective cohort study included all consecutive patients who underwent TLTG for gastric cancer (GC) from 2012 to 2016 at 2 affiliated teaching hospitals. All participating surgeons performed standardized intracorporeal 2-layer hand-sewn EJ. Results: We included 51 patients who underwent TLTG for GC and standardized EJ anastomosis. Twenty-seven (53%) were male, and the median age was 60 (36-87) years. The average operative time was $337{\pm}71minutes$ and intraoperative bleeding was $160{\pm}107mL$. There were no open conversions related to EJ. Postoperative morbidity was observed in 9 (17.0%) patients. There was no postoperative mortality. EJ leakage was observed in 2 patients (3.8%) and 1 patient (1.9%) developed EJ stenosis. Patients with leakage were managed non-operatively and the patient with stenosis required endoscopic dilation. The median length of hospital stay was 8 (6-29) days. Conclusions: Two-layer hand-sewn EJ during TLTG for GC is a feasible and safe technique. This method avoids a laparotomy for reconstruction and the disadvantages associated with laparoscopic introduction of mechanical staplers for EJ, and provides an alternative for alimentary tract reconstruction after TLTG.

• Journal of Chest Surgery
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• v.54 no.4
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• pp.302-309
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• 2021

Totally robotic esophagectomy is performed using a robotic technique without additional thoracoscopy or laparoscopy. However, most robotic esophagectomies are currently performed in a hybrid form combining robotic and other endoscopic techniques. Laparoscopic stomach mobilization and thoracoscopic esophagogastric anastomosis are commonly used methods in robotic esophagectomy. In this paper, totally robotic esophagectomy without thoracoscopic or laparoscopic assistance is presented.

• Korean Journal of Bronchoesophagology
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• v.4 no.1
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• pp.15-26
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• 1998

The first successful transthoracic esophagectomy and intrathoracic esophago- gastric anastomosis reported in 1938. Stomach, small intestine, and colon as well as free revascularized grafts have been substituted for excised esophagus. During the past 60 years, there have been substantial advances in preoperative assessment, nutritional support, anesthetic and operative techniques, and postoperative care of patients undergoing esophageal resection and reconstruction. However the hospital mortality and morbidity of esophageal resection and reconstruction is still high and disruption of an intrathoracic esophagogastric anastomosis continues to be the most dreaded complication of esophageal surgery, And the choice of the conduit is still controversial. In this paper, I would like to review the current surgical options available to patients who require esophageal resection and reconstruction as well as the advantages and disadvantages of each technique.