Application of circular stapler in the reconstruction of intrathoracic esophagus / 中华消化外科杂志

ABSTRACT

Objective To review the outeonle of intrathoracic esophageal reconstruction using circular stapler after esophageal or cardiac cancer resection.Methods From June 1996 to April 2007,744 patients underwent tumor removal and intrathoracie esophageal reconstruction in Daping Hospital.Of all patients,658 suffered from thoracic esophageal cancer and the other 86 from cardiac cancer.The operative modalities consisted of gastroesophageal anastomosis at the top of tim thoracic cavity or above the aortic arch in 402 patients,gastroesophageal anastomosis below the aortic arch in 317,and total gastrectomy in 25(esophageal replacement with colon in 21 patients and esophagojejunostomy in 4).Results Anastomotie bleeding oecurred in 5 patients intraoperatively.One patient died of acute respiratory distress syndrome,1 of septic shock and 1 of hepatic failure postoperatively.Psychiatric disorder was observed in 5 patients,respiratory complications in 34,anastomotie fistula in 4,and anastomotic stricture in 20.Three weeks after the operation,the esophageal manometric examination in 25 patients showed that intraesophageal,anastomotie and intragastric pressures were(-0.2±2.0),(1 1.2±4.4)and(2.4±1.5)mm Hg(1 mm Hg=0.133 kPa),respectively.Twenty-four hour pH monitoring demonstrated that 13 patients had abnormal DeMeester score(＞14.72),3 of thenl developed reflux symptoms and got relieved after receiving acid suppression therapy for 1.0-2.2 months.The 13 patients with abnormal DeMeester score were followed up for 3-38 months,and the pH value of the esophagus was back to normal in 2 patients,and it almost remained the same in 9 patients.Two patients died of tumor reculTenee of metastasis.Conclusions Intratlmracic esophageal reconstruction with circular stapler is safe,reliable and able to reduce the postoperative complications such as anastomotic fistula.