Terminalized semimechanical side-to-side suture technique for cervical esophagogastrostomy

Background. The classic manual end-to-side technique of esophagogastrostomy after gastric pull-up to the neck carries a rather high risk of fistula and stricture. Methods. A terminalized semimechanical side-to-side technique of cervical esophagogastrostomy was performed in 16 patients by the application of an Endo-GPA stapler across the gastric and esophageal walls placed side by side, so as to create a V-shaped posterior opening between the two lumina. The anterior aspect of the anastomosis was hand-sewn using a classic running suture. The cross-sectional area of the semimechanical anastomoses was estimated by barium swallow study 2 months after operation and compared with that of 24 manual end-to-side esophagogastrostomies. Results. The cross-sectional area was 225 +/- 15.7 mm(2) (mean a standard error of the mean) or the 16 semimechanical anastomoses versus 136 +/- 15 mm(2) for the 24 manual anastomoses (p = 0.0001). The anastomotic area decreased from 206.6 +/- 13.5 mm(2) in 29 patients without dysphagia to 107.5 +/- 4.7 mm(2) in 7 patients with moderate dysphagia for solids that did not require endoscopic dilation and to 55.7 +/- 16 mm(2) in 4 patients with severe dysphagia that required dilation (p = 0). The anastomotic area in 6 of the 7 patients with initial moderate dysphagia for solids increased spontaneously with time from 107.3 +/- 5.5 mm(2) to 174.6 +/- 8.1 mm(2), with concomitant symptomatic relief (p = 0.0277). Conclusions. The terminalized semimechanical side-to-side suture technique produces a larger anastomosis than the classic end-to-side esophagogastrostomy technique. inflammatory changes related to the operation may cause transient narrowing of a cervical esophagogastrostomy. (C) 1998 by The Society of Thoracic Surgeons.