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  Global Journal of Surgery. Volume 2, Issue 1 (2011) pp. 10-17
  Research Article
Functional outcome and stricture rates with the use of circular stapler for esophagogastric anastomosis after esophagectomy
  Idit Sifronya, Guy Pinesb, Ehud Melzerc, Yoram Kleinb, Victor Buyevizb, Hanoch Kashtanb,*  
a Hebrew University School of Medicine, Jerusalem, Israel
b Department of Surgery B, Kaplan Medical Center, Rehovot, Israel
c Department of Gastroenterology and Liver Diseases, Kaplan Medical Center, Rehovot and Hebrew University School of Medicine, Jerusalem, Israel

  Introduction: We evaluated functional outcome and long term results of circular stapled and hand-sewn esophagogastric anastomosis after esophagectomy. Experimental: Records of all patients who underwent esophagectomy during 2003 - 2008 were reviewed. Anastomosis was done either hand-sewn or using a circular stapler. Patients were interviewed regarding foregut symptoms and eating habits. Results and Discussion: 85 patients (average age 64, M/F 63/22) were included. Median follow-up was 20 months. Thirty-one patients underwent hand-sewn anastomosis and 54 patients underwent circular stapled one. Stricture occurred in 6 (19.3%) patients in the hand-sewn group and 7 (12.9%) patients in the circular stapler group. All patients were treated successfully with dilations alone. Risk factors associated with stricture development included male gender, cervical esophagogastric anastomosis and anastomotic leak. 38 patients answered the questionnaire. Patients consumed a median of 4 meals per day, and most (n=24, 63%) had no dietary restrictions. Meal size was smaller compared to pre-operative state. Mean symptom severity scores improved for all symptoms except regurgitation and choking. No difference was found between the two groups. Conclusions: Esophagogastric anastomosis using circular staplers is feasible, safe, and has comparable outcomes to hand-sewn anastomosis in terms of anastomotic stricture rates.
  Esophageal neoplasm; Esophagectomy; Anastomotic stricture; Stapler anastomosis  

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