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. |
