Abstract

Introduction: A good gastro-oesophageal anastomosis in a minimally invasive oesophagectomy (MIO) determines immediate post-operative recovery. Thoracoscopic anastomosis can be performed using a linear stapler, a circular stapler, or can be performed fully hand-sewn. This teaching video shows a fully hand-sewn technique using barbed sutures. We compare leak rates between handsewn and the circular stapler anastomosis at a high-volume tertiary centre in the UK. We created this video for technical teaching purposes and for use in a cadaveric dissection course for MIOs. 

Methods: A prospectively maintained database was analysed retrospectively. We compared the leak rates of fully hand-sewn anastomosis (performed during the completely minimally invasive technique) to circular stapled anastomosis (performed during hybrid technique).  

Results: A total of 382 two-stage oesophagectomy procedures were performed between June 2013 and December 2018. Of these 228 were stapled anastomosis and 154 were hand-sewn.  The leak rate in the handsewn group was 9.74% and the stapled group, 8.77%. There was no significant difference (χ² = 0.104, P=0.769) in anastomotic leaks between the hand sewn group versus the stapled group.

Conclusion: We present a technique for fully hand sewn gastro-oesophageal anastomosis. Our data shows that there is no significant difference in anastomotic leak rates between stapled and hand-sewn anastomotic technique. Both techniques, at this centre, fall below the reported leak incidence range of 11.4 to 21.2% [1]. The fully hand-sewn intrathoracic anastomosis shown in the video is a safe and effective technique.

Reference:

1. Fabbi M, Hagens ERC, van Berge Henegouwen MI and Gisbertz SS. Anastomotic leakage after esophagectomy for esophageal cancer: definitions, diagnostics, and treatment. Diseases of the Esophagus 2021;  34(1): doaa039. https://doi.org/10.1093/dote/doaa039

Additional Information

This presentation was given at the SES 2022 online conference, January 2022.