Sleeve cervical esophaceal anastomosis: A trial to reduce postoperative leakage
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Leakage of the cervical anastomosis is a common complication in esophageal surgery for cancer. Lack of serosa in the esophagus can be considered as an important factor. Serosal covering of the anastomotic line can be provided from the esophageal substitute ( stomach or colon); if the residual esophagus is anastomosed to the mucosa of the substitute and this line is covered by a seromuscular cuff from the latter, this is the sleeve anastomosis. In this study this sleeve technique was compared to the single layer continuous technique as regarding the occurrence of postoperative leakage. Sixty three patients subjected to surgery for carcinoma of the esophagus were included in this work, of them 32 cases (51%) had irresectable lesions and were treated by a palliative colon by-pass operation. In 31 patients (49%) the tumor was resectable and they were treated by esophagectomy and gastric pull up in 19 cases and greater curve gastric tube in 12 patients. In all cases the anastomosis between the substitute and the esophagus was done in the neck. It was done by the one layer continuous suture in 31 patients and by the sleeve technique in 32 cases. Postoperative leakage occurred in 14/31 patients of the first group (45%) and in only 5/32 cases in the second group (15%), p < 0.001. This leakage stopped earlier in the group of the sleeve anastomosis and their stay in the hospital was much shorter p < 0.01. From this study it was found also that the incidence of leakage was more with the use of gastric tube than with the use of colon or whole stomach . So, it is preferred to use the whole stomach or the colon as an esophageal substitute and to use the sleeve anastomosis to decrease postoperative leakage and this will allow the patients to eat, normally, earlier and also will reduce the hospital stay and costs.