Mid-term Outcomes of Side-to-Side Stapled Anastomosis in Cervical Esophagogastrostomy

This study was conducted to evaluate the mid-term results of cervical esophagogastric anastomosis using a side-to-side stapled anastomosis method for treatment of patients with malignant esophageal disease. A total of 13 patients were reviewed retrospectively from January 2001 to November 2005 who underwent total esophagectomy through a right thoracotomy, gastric tube formation through a midline laparotomy and finally a cervical esophagogastric anastomosis. Average patient age was 62.6 yr old and the male to female ratio was 11:2. The mean anastomosis time was measured to be about 32.5 min; all patients were followed for about 22.8+/-9.9 months postoperatively. There were no early or late mortalities. There were no complications of anastomosis site leakage or conduit necrosis. A mild anastomotic stricture was noted in one patient, and required two endoscopic bougination procedures at postoperative 4th month. Construction of a cervical esophagogastric anastomosis by side-to-side stapled anastomosis is relatively easy to apply and can be performed in a timely manner. Follow up outcomes are very good. We, therefore, suggest that the side-to-side stapled anastomosis could be used as a safe and effective option for cervical esophagogastric anastomosis.

Mid-term Outcomes of Side-to-Side Stapled Anastomosis in Cervical Esophagogastrostomy

This study was conducted to evaluate the mid-term results of cervical esophagogastric anastomosis using a side-to-side stapled anastomosis method for treatment of patients with malignant esophageal disease. A total of 13 patients were reviewed retrospectively from January 2001 to November 2005 who underwent total esophagectomy through a right thoracotomy, gastric tube formation through a midline laparotomy and finally a cervical esophagogastric anastomosis. Average patient age was 62.6 yr old and the male to female ratio was 11:2. The mean anastomosis time was measured to be about 32.5 min; all patients were followed for about 22.8+/-9.9 months postoperatively. There were no early or late mortalities. There were no complications of anastomosis site leakage or conduit necrosis. A mild anastomotic stricture was noted in one patient, and required two endoscopic bougination procedures at postoperative 4th month. Construction of a cervical esophagogastric anastomosis by side-to-side stapled anastomosis is relatively easy to apply and can be performed in a timely manner. Follow up outcomes are very good. We, therefore, suggest that the side-to-side stapled anastomosis could be used as a safe and effective option for cervical esophagogastric anastomosis.

Esofagomiotomía: técnica abierta versus laparoscópica. Modelo experimental piloto en rata Wistar / Esophago-myotomy: Open vs laparoscopic technique. An experimental model utilizing Wistar rats

Este modelo piloto se planeó para adiestrar cirujanos pediatras o generales en técnicas de laparoscopia avanzada y para comparar dos abordajes quirúrgicos distintos como son la vía laparoscópica y la vía tradicional. Se conformaron dos grupos con 10 ratas Wistar cada uno. A todos los animales se les realizó esofagomiotomía; a las de un grupo con técnica abierta y los del otro con técnica laparoscópica. Después de la cirugía, las ratas fueron mantenidas vivas por un mínimo de tres semanas. Antes de sacrificar a los animales, a cada uno se le realizó laparoscopia para registrar en vídeo los hallazgos y evaluar los resultados. Se efectuaron cortes histológicos del área quirúrgica a todas las piezas de autopsia. El tiempo requirio para la cirugía fue similar en ambos grupos: siete a 12 minutos con la técnica abierta (promedio de 10 minutos) y seis a 20 con la laparoscópica (media de 12 minutos). No hubo mortalidad. No se registraron diferencias en la evolución posoperatoria. En cuanto a la formación de adherencias, el grupo con técnica abierta apreciativamente mostró un grado mayor que su contraparte laparoscópica. Los hallazgos del estudio de histología no se correlacionan con las observaciones clínicas, por lo que no son útiles para establecer una clasificación con base en ellos. La rata es un modelo experimental adecuado para realizar protocolos de investigación quirúrgica. La esofagomiotomía es un procedimiento posible de efectuar en la rata, tanto por vía tradicional como por vía laparoscópica. El abordaje laparoscópico, per se, disminuyó la formación de adherencias postoperatorias en este modelo