Oesophageal surgery

Prevention of anastomotic stricture with a purse-string suture technique on the gastric side during esophageal carcinoma operations: retrospective study of 463 consecutive cases

OBJECTIVE

The objective of this study was to investigate the effect of a gastric side purse-string technique on anastomotic strictures during esophageal carcinoma operations.

METHODS

From 1996 to 2005, esophageal carcinoma operations were performed on 1128 consecutive patients. Among them, 463 underwent esophagogastric anastomosis with purse-string sutures on the gastric side (purse group) and the other 665 did not (nonpurse group). Anastomotic strictures, reflux, and leakage were analyzed and compared between the two groups after the operations.

RESULTS

Complete follow-up was conducted on all 1128 patients within 6 months after the operation. In contrast to the nonpurse group with a postoperative anastomotic stricture rate of 5.4% (36/665), the purse group demonstrated a significantly lower rate (0.2%, 1/463). The occurrence rates of anastomotic leakage in the nonpurse and purse groups were 0.9% (6/665) and 0.4% (2/463), respectively. Of the 17 cases of gastroesophageal reflux, 15 (15/665, 1.8%) were found in the nonpurse group and 2 (2/463, 1.1%) in the purse group.

CONCLUSIONS

Thus, a purse-string suture technique on the gastric side might be an effective method for preventing the occurrence of anastomotic strictures after esophageal resection.

Diffuse esophageal spasm

The purpose of this article is to review the clinical features, pathophysiology, diagnosis, and management of patients with diffuse esophageal spasm (DES). The PubMed database was searched with a focus on recent publications, using keywords "DES," plus "epidemiology," "prevalence," "diagnosis," "pathogenesis," "calcium channel blocker," "nitrates," "botulinum toxin," "antidepressants," "dilation," and "myotomy." The reference lists of papers identified in the initial PubMed search were reviewed for further relevant publications.

Influence of esophageal carcinoma operations on gastroesophageal reflux

BACKGROUND

Gastroesophageal reflux occurs more easily after esophageal carcinoma operations. Our objective was to compare the influence of three kinds of esophageal carcinoma operations on reflux.

METHODS

From May 1999 to May 2002, esophageal carcinoma operations were performed on 30 consecutive patients through left thoracotomy, including 10 cases completed with supraaortic, ante-aortic gastroesophageal anastomosis, 10 cases with subaortic gastroesophageal anastomosis, and 10 cases with apicothoracic retro-aortic gastroesophageal anastomosis. A 24-hour esophageal pH was recorded for every patient 3 months after the operation.

RESULTS

The number of reflux episodes per 24 hours (No. of episodes), the number of reflux episodes greater than or equal to 5 minutes per 24 hours (No. > or = 5 min), the time in minutes of the longest reflux episode recorded (longest episode) and the cumulative time of the esophageal pH less than 4 (total time that pH < 4) are all beyond normal limits. The difference in number of episodes between supraaortic, ante-aortic, and subaortic gastroesophageal anastomosis groups is not significant; but the other indexes are higher in the supraaortic, ante-aortic anastomosis group with significance (p < 0.05). The difference in number of episodes between supraaortic, ante-aortic, and apicothoracic retro-aortic gastroesophageal anastomosis groups is not significant while the other indexes are much higher in the supraaortic, ante-aortic anastomosis group with significance (p < 0.05); the difference in number of episodes between apicothoracic retro-aortic and subaortic gastroesophageal anastomosis groups is not significant while the other indexes are lower in the apicothoracic retro-aortic anastomosis group with significance (p < 0.05).

CONCLUSIONS

Gastroesophageal reflux occurred after all three types of esophageal carcinoma operations. The reflux is less severe in the apicothoracic retro-aortic anastomosis group than in the other two groups. The esophageal carcinoma operation with apicothoracic retro-aortic gastroesophageal anastomosis has more advantages to alleviate postoperative gastroesophageal reflux.

A new three-layer-funnel-shaped esophagogastric anastomosis for surgical treatment of esophageal carcinoma

AIM: To reduce the incidence of postoperative anastomotic leak, stenosis, gastroesophageal reflux (GER) for patients with esophageal carcinoma, and to evaluate the conventional method of esophagectomy and esophagogastroplasty modified by a new three-layer-funnel-shaped (TLF) esophagogastric anastomotic suturing technique.

METHODS: From January 1997 to October 1999, patients with clinical stage I and II (IIa and IIb) esophageal carcinoma, which met the enrollment criteria, were surgically treated by the new method (Group A) and by conventional operation (Group B). All the patients were followed at least for 6 months. Postoperative outcomes and complications were recorded and compared with the conventional method in the same hospitals and with that reported previously by McLarty et al^[7] in 1997 (Group C).

RESULTS: 58 cases with stage I and II (IIa and IIb) esophageal carcinoma, including 38 males and 20 females aged from 34 to 78 (mean age: 57), were surgically treated by the TLF anastomosis and 64 by conventional method in our hospitals from January 1997 to October 1999. The quality of swallowing was improved significantly (Wilcoxon W = 2142, P = 0.0001) 2 to 3 months after the new operation in Group A. Only one patient had a blind anastomatic fistula diagnosed by barium swallow test 2 months but healed up 3 weeks later. Postoperative complications occurred in 25 (43%) patients, anastomotic stenosis in 8 (14%), and GER in 13 (22%). The incidences of postoperative anastomotic leak, stenosis and GER were significantly decreased by the TLF anastomosis method compared with that of conventional methods (χ² = 6.566, P = 0.038; χ² = 10.214, P = 0.006; χ² = 21.265, P = 0.000).

CONCLUSION: The new three-layer-funnel-shaped esophagogastric anastomosis (TLFEGA) has more advantages to reduce postoperative complications of anastomotic leak, stricture and GER.