Mucosal Tube Technique for Creation of Esophageal Anastomosis After Esophagectomy

Robroy H. MacIver, Sudhir Sundaresan, Alberto L. DeHoyos, Mark Sisco, Matthew G. Blum

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: The definitive treatment of esophageal cancer remains surgical resection. Morbidity and mortality are highly influenced by the success of the anastomosis created in the reconstruction of the resected esophagus. The results of an anastomotic technique that creates an esophageal mucosal tube are analyzed. Methods: The medical records of all patients undergoing esophagectomy at a single institution by 3 surgeons between January 2002 and July 2008 were reviewed. Patients who underwent a 2-layer, hand-sewn, esophageal anastomosis using a mucosal tube were included. The unique aspect of the anastomosis was the creation of an esophageal mucosal tube that facilitates a tension-free, precise mucosal approximation. Results: Of the 61 patients who underwent esophageal reconstructions (60 gastric, 1 colonic), 49 (80%) had a diagnosis of esophageal neoplasm. Of those with cancer, 20 (41%) had neoadjuvant therapy before the resection. Two patients presented with perforation. The anastomoses were intrathoracic in 57 of 61 (93%) and cervical in 4 cervical. There were no operative deaths. All patients underwent contrast study at an average of 5 days postoperatively. The anastomotic leak rate was 2% (1 of 61). Postoperative dilations (mean, 1.3 dilations) were done in 12 of 61 patients (20%), using a low symptom threshold for endoscopy and dilation. Conclusions: The use of the esophageal mucosal tube and 2-layer anastomosis is a robust technique that results in a low leak rate. Strictures are minimal and easily dilated if they occur. Use of a gastrotomy larger than 2.5 cm may decrease stricture rates.

Original languageEnglish (US)
Pages (from-to)1703-1707
Number of pages5
JournalAnnals of Thoracic Surgery
Volume87
Issue number6
DOIs
StatePublished - Jun 1 2009

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Esophagectomy
Dilatation
Esophageal Neoplasms
Pathologic Constriction
Anastomotic Leak
Neoadjuvant Therapy
Esophagus
Endoscopy
Medical Records
Stomach
Hand
Morbidity
Mortality
Neoplasms

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Mucosal Tube Technique for Creation of Esophageal Anastomosis After Esophagectomy. / MacIver, Robroy H.; Sundaresan, Sudhir; DeHoyos, Alberto L.; Sisco, Mark; Blum, Matthew G.

In: Annals of Thoracic Surgery, Vol. 87, No. 6, 01.06.2009, p. 1703-1707.

Research output: Contribution to journalArticle

MacIver, Robroy H. ; Sundaresan, Sudhir ; DeHoyos, Alberto L. ; Sisco, Mark ; Blum, Matthew G. / Mucosal Tube Technique for Creation of Esophageal Anastomosis After Esophagectomy. In: Annals of Thoracic Surgery. 2009 ; Vol. 87, No. 6. pp. 1703-1707.
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