An Analysis of Complications according to Cartridge Size Following Total Gastrectomy with Roux-en-Y Esophagojejunostomy Using the EEA Stapler

ABSTRACT

PURPOSE: Anastomotic stricture is one of the most common problems in esophagojejunostomy using an end-to-end anastomosing (EEA) instrument following total gastrectomy. Because anastomotic stricture often develops with small- cartridge EEA, a larger EEA may be used to avoid stricture. The purpose of this retrospective study is to evaluate the difference of complications between patients treated using the EEA25 and ones using EEA28. METHODS: A total of 283 patients underwent curative total gastrectomy and esophagojejunostomy with Roux-en-Y anastomosis, using EEA25 or EEA28, between January 1992 and December 1999. The differences between the EEA25 and EEA28 groups were investigated by comparing them in terms of reflux esophagitis, dysphagia, and stricture. RESULTS: Stricture developed in five patients (13.8%) in the EEA28 group and in 11 patients (4.45%) in the EEA25 group (P<0.05), dysphagia was experienced less frequently in the EEA25 than in the EEA28 group (P<0.05), and no significant differences were evident with regards to reflux esophagitis. CONCLUSION: The choice of a large EEA to avoid anastomotic stricture did not affect the development of dysphagia or stricture. However, a randomized, prospective study should be done to better define the relationship between the size of EEA and the complications of total gastrectomy.