Incidence of anastomotic stricture after Ivor-Lewis oesophagectomy using a circular stapling device

Abstract Introduction Esophagectomy is the gold standard in the surgical therapy of esophageal cancer. It is either performed thoracoabdominal with a intrathoracic anastomosis or in proximal cancers with a three-incision esophagectomy and cervical reconstruction. Delayed gastric conduit emptying (DGCE) is the most common functional postoperative disorder after Ivor-Lewis esophagectomy (IL). Pneumonia is significantly more often in patients with DGCE. It remains unclear if DGCE anastomotic leakage (AL) is associated. Aim of our study is to analyze, if AL is more likely to happen in patients with a DGCE. Patients and methods 816 patients were included. All patients have had an IL due to esophageal/esophagogastric-junction cancer between 2013 and 2018 in our center. Intrathoracic esophagogastric end-to-side anastomosis was performed with a circular stapling device. The collective has been divided in two groups depending on the occurrence of DGCE. The diagnosis DGCE was determined by clinical and radiologic criteria in accordance with current international expert consensus. Results 27.7% of all patients suffered from DGCE postoperatively. Female patients had a significantly higher chance to suffer from DGCE than male patients (34.4% vs. 26.2% vs., p = 0.040). Pneumonia was more common in patients with DGCE (13.7% vs. 8.5%, p = 0.025), furthermore hospitalization was longer in DGCE patients (median 17 days vs. 14d, p < 0.001). There was no difference in the rate of type II anastomotic leakage, (5.8% in both groups DGCE). All patients with ECCG type II AL (n = 47; 5.8%) were treated successfully by endoluminal/endoscopic therapy. The subgroup analysis showed that ASA ≥ III (7.6% vs. 4.4%, p = 0.05) and the histology squamous cell carcinoma (9.8% vs. 4.7%, p = 0.01) were independent risk factors for the occurrence of an AL. Conclusion Our study confirms that DGCE after IL is a common finding in a standardized collective of patients in a high-volume center. This functional disorder is associated with a higher rate of pneumonia and a prolonged hospital stay. Still, there is no association between DGCE and the occurrence of an AL after esophagectomy. The hypothesis, that an DGCE results in a higher pressure on the anastomosis and therefore to an AL in consequence, can be refuted. DGCE is not a pathogenetic factor for an AL.

Download Full-text

Side-to-side esophagogastric anastomosis for minimally invasive Ivor-Lewis esophagectomy: operative technique and short-term outcomes

Updates in Surgery ◽

10.1007/s13304-021-01054-y ◽

2021 ◽

Author(s):

Manrica Fabbi ◽

Stefano De Pascale ◽

Filippo Ascari ◽

Wanda Luisa Petz ◽

Uberto Fumagalli Romario

Keyword(s):

Minimally Invasive ◽

Anastomotic Leak ◽

Anastomotic Stricture ◽

Surgical Techniques ◽

Length Of Hospital Stay ◽

Pulmonary Complications ◽

Open Approach ◽

Short Term ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy

AbstractTotally minimally invasive Ivor-Lewis esophagectomy (TMIIL) is associated to lower rate of post-operative complication, decreases length of hospital stay and improves quality of life compared to open approach. Nevertheless, adaptation of TMIIL still proceeds at slow pace, mainly due to the difficulty to perform the intra-thoracic anastomosis and heterogeneity of surgical techniques. We present our experience with TMIIL utilizing a stapled side-to-side anastomosis. We retrospectively evaluated 36 patients who underwent a planned TMIIL from January 2017 to September 2020. Esophagogastric anastomoses were performed using a 3-cm linear-stapled side-to-side technique. General features, operative techniques, pathology data and short-term outcomes were analyzed. The median operative time was 365 min (ranging from 240 to 480 min) with a median blood loss of 100 ml (50–1000 ml). The median overall length of stay was 13 (7–64) days and in-hospital mortality rate was 2.8%. Two patients (5.6%) had an anastomotic leak, without need for operative intervention and another patient developed an anastomotic stricture, resolved with a single endoscopic dilation. Chylothorax occurred in three patients; two of these required a surgical intervention. Pulmonary complications occurred in six patients (16.7%). Based on Comprehensive Complications Index (CCI), median values of complications were 27.9 (ranging from 20.9 to 100). The results of our study suggest that TMIIL with a 3-cm linear-stapled anastomosis seems to be safe and effective, with low rates of post-operative anastomotic leak and stricture.

Download Full-text

Anastomotic stricture after Ivor Lewis esophagectomy: An evaluation of incidence, risk factors, and treatment

Surgery ◽

10.1016/j.surg.2021.07.034 ◽

2021 ◽

Author(s):

Renol M. Koshy ◽

Joshua M. Brown ◽

Jakub Chmelo ◽

Thomas Watkinson ◽

Alexander W. Phillips

Keyword(s):

Risk Factors ◽

Anastomotic Stricture ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Incidence Risk

Download Full-text

Low Anastomotic Stricture Rate After Roux-en-Y Gastric Bypass Using a 21-mm Circular Stapling Device

Obesity Surgery ◽

10.1007/s11695-012-0671-7 ◽

2012 ◽

Vol 22 (9) ◽

pp. 1491-1495 ◽

Cited By ~ 15

Author(s):

A. Rondan ◽

S. Nijhawan ◽

S. Majid ◽

Tracy Martinez ◽

Alan C. Wittgrove

Keyword(s):

Gastric Bypass ◽

Anastomotic Stricture ◽

Stapling Device ◽

Stricture Rate

Download Full-text

Using the Hand-Sewn Purse-String Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0038-1660848 ◽

2018 ◽

Vol 67 (07) ◽

pp. 578-584 ◽

Cited By ~ 1

Author(s):

Bicheng Zhan ◽

Jian Chen ◽

Shaoming Du ◽

Yanzheng Xiong ◽

Jian Liu

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Anastomotic Stricture ◽

Circular Stapler ◽

Fixation Time ◽

Purse String ◽

Ivor Lewis ◽

Anastomotic Technique ◽

Open Esophagectomy ◽

Ivor Lewis Esophagectomy

Background Minimally invasive Ivor Lewis esophagectomy (MIILE) is increasingly being used in the treatment of middle or lower esophageal cancer. Hand-sewn purse-string stapled anastomosis is a classic approach in open esophagectomy. However, this procedure is technically difficult under thoracoscopy. The hardest part is delivering the anvil into the esophageal stump. Herein, we report an approach to performing this step under thoracoscopy. Methods A total of 257 consecutive patients who underwent MIILE between April 2013 and July 2017 were analyzed retrospectively. The operator hand sewed the purse string using silk thread under thoracoscopy, and the 25-mm circular stapler was passed through the anterior axillary line at the fourth intercostal space to finish the side-to-end gastroesophageal anastomosis. Patient demographics, intraoperative data, postoperative complications were evaluated. Results The mean operative time, thoracoscopy time, and anvil fixation time was 307.0 ± 34.3, 155.4 ± 21.5, and 7.1 ± 1.6 minute, respectively. The anastomotic leak and anastomotic stricture occurred in 6.6% (17 of 257) and 3.9% (10 of 257) of patients, respectively. There was no intraoperative death; one case was death of acute respiratory distress syndrome (ARDS) for conduit gastric leakage on the 21st postoperative day. Conclusion Using the hand-sewn purse-string stapled anastomotic technique for MIILE is feasible and relatively safe in patients with middle or lower esophageal cancer.

Download Full-text

Reconstruction of the esophagus of patients with middle thoracic esophageal carcinoma using the remnant stomach following Billroth II gastrectomy

Diseases of the Esophagus ◽

10.1093/dote/doaa077 ◽

2020 ◽

Author(s):

Zhangfan Mao ◽

Bo Wang ◽

Ping Dong ◽

Gaoli Liu ◽

Haifeng Hu ◽

...

Keyword(s):

Esophageal Carcinoma ◽

Distal Gastrectomy ◽

Anastomotic Stricture ◽

Remnant Stomach ◽

Thoracic Esophageal Cancer ◽

Left Hemithorax ◽

Ivor Lewis ◽

Billroth Ii Gastrectomy ◽

History Of ◽

Feeding Vessels

Abstract It seems impossible to reconstruct the esophagus of patients with middle thoracic esophageal carcinoma with a history of distal gastrectomy using the remnant stomach. Although surgeons have made multiple efforts to reconstruct the esophagus using the remnant stomach, it can only be successfully used in cases of lower thoracic esophageal cancer. Additionally, the surgery is more complex than traditional esophagogastrostomy due to challenges including mobilization of the remnant stomach with the spleen and transposition of the pancreatic tail into the left hemithorax. Our operation proved that the remnant stomach, which we named as the completely mobilized remnant stomach after dissection of the feeding vessels, remained viable. We successfully integrated the completely mobilized remnant stomach in the reconstruction of the lower thoracic esophageal tract and then integrated it in Ivor Lewis esophagogastrostomy. We describe this new alternative surgical technique for the treatment of middle thoracic esophageal carcinoma in patients with a history of distal gastrectomy in this study. Clinical data of 23 patients from 2008 to 2019 were retrospectively analyzed. All patients underwent the Ivor Lewis procedure. All remaining vessels of the remnant stomach were dissected at their origins, and Roux-en-Y reconstruction or Braun anastomosis was performed. After esophagectomy during right thoracotomy, anastomosis of the remnant stomach and esophagus was performed. Two-field lymph node dissections were performed. There was no case of necrosis of the remnant stomach or of perioperative death. Serious complications included anastomotic leak in three cases, afferent-efferent loop syndrome in one, and anastomotic stricture in two. Application of the completely mobilized remnant stomach in Ivor Lewis esophagogastrostomy is feasible, and the surgical procedure is similar to that of normal esophagogastrostomy.

Download Full-text

Fluoroscopically Guided Balloon Dilation for Benign Anastomotic Stricture after Ivor-Lewis Esophagectomy: Experience in 62 Patients

Journal of Vascular and Interventional Radiology ◽

10.1097/01.rvi.0000185417.89885.2e ◽

2005 ◽

Vol 16 (12) ◽

pp. 1699-1704 ◽

Cited By ~ 20

Author(s):

Hyo-Cheol Kim ◽

Ji Hoon Shin ◽

Ho-Young Song ◽

Seung-Il Park ◽

Gi-Young Ko ◽

...

Keyword(s):

Anastomotic Stricture ◽

Balloon Dilation ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy

Download Full-text

The Circular Stapled Esophagogastric Anastomosis in Esophagectomy: No Differences in Anastomotic Insufficiency and Stricture Rates Between the 25 mm and 28 mm Circular Stapler

Journal of Gastrointestinal Surgery ◽

10.1007/s11605-020-04895-x ◽

2021 ◽

Author(s):

E. Tagkalos ◽

P. C. van der Sluis ◽

E. Uzun ◽

F. Berlth ◽

J. Staubitz ◽

...

Keyword(s):

Anastomotic Stricture ◽

Circular Stapler ◽

Median Number ◽

Stapled Anastomosis ◽

Esophagogastric Anastomosis ◽

Ivor Lewis ◽

Anastomotic Insufficiency ◽

Ivor Lewis Esophagectomy ◽

Stricture Rate ◽

Anastomotic Strictures

Abstract Background For patients undergoing an Ivor Lewis esophagectomy with a circular stapled anastomosis, the optimal diameter of the used circular stapler to restore continuity is unknown. The aim of this study was to compare the 25 mm stapled versus the 28 mm stapled esophagogastric anastomosis after Ivor Lewis esophagectomy, focusing on anastomotic insufficiency and postoperative anastomotic strictures. Methods Between February 2008 and June 2019, 349 consecutive patients underwent Ivor Lewis esophagectomy with gastric conduit reconstruction and circular stapled anastomosis. Patient characteristics and postoperative results, such as anastomotic insufficiency rates, postoperative anastomotic stricture rates, time to anastomotic stricture rate, and the number of dilatations, were recorded in a prospective database and analyzed. Results In 222 patients (64%), the 25 mm circular stapler was used and in 127 patients (36%) the 28 mm circular stapler was used. There were no differences in baseline characteristics. Anastomotic insufficiency rates were comparable between the 25 mm (12%) and the 28 mm groups (11%) (p = 0.751). There were no differences between postoperative anastomotic strictures in the 25 mm (14%) and the 28 mm groups (14%) (p = 0.863). Within patients with postoperative anastomotic strictures, a median number of 2 dilatations were observed in each group (p = 0.573) without differences in the time to first diagnosis (p = 0.412). Conclusion There were no differences in anastomotic insufficiency and postoperative anastomotic stricture rates between the 25 mm and the 28 mm circular stapled esophagogastric anastomosis after Ivor Lewis esophagectomy. Both the 25 mm and 28 mm stapler can be safely used to create a circular stapled esophagogastric anastomosis to restore continuity after esophagectomy.

Download Full-text