Hand Sewn Versus Stapled Anastomosis for Esophagostomy.

Abstract

Background:The most common method of treating esophageal cancer is esophagectomy. Reconstruction involves the use of esophagogastric anastomosis, and this could be done by either hand-sewing or stapling. Anastomotic issues such as leaks and strictures have a great impact on morbidity, mortality, and postoperative recovery. The best approach is still controversial, and study indicates inconsistent results for both approaches.

Objectives: The objective of the study was to compare hand-sewn and stapled esophagogastric anastomosis among patients who underwent esophagectomy in terms of operating time, anastomotic leakage, stricture, hospitalization, and general postoperative recovery.

Methodology: A prospective comparative study was conducted at Thoracic Surgery department, Lady Reading Hospital Peshawar KPK Pakistan from jan 2020 to jan 2021.based on 100 patients with elective esophagectomy and randomized to the groups of hand-sewn anastomosis (n=50) and stapled anastomosis (n=50). Demographics, comorbidities, the location of the tumor, and preoperative investigations were documented. Measures were taken of operative time, blood loss, intraoperative complications, anastomotic leak, stricture formation, hospital stay, and mortality within 30 days. Statistical tests were done using Student's t-test to analyse continuous variables and the Chi-square test to analyse categorical variables. The data are presented in the mean ± standard deviation (SD), with a p-value of less than 0.05 being regarded as significant.

Results :Mean age was 58.4 ± 9.2 years in the hand-sewn group and 57.6 ± 8.7 years in the stapled group (p=0.68). Operative time was shorter for stapled anastomosis (205 ± 20 min vs 240 ± 25 min, p<0.001). Blood loss was similar (280 ± 50 mL vs 265 ± 45 mL, p=0.12). Anastomotic leaks occurred in 8% vs 6% (p=0.68), and strictures in 12% vs 6% (p=0.27). Stapled anastomosis was associated with shorter hospital stay (10 ± 2 days vs 12 ± 3 days, p=0.004). No 30-day mortality occurred.

Conclusion: Compared to end-to-end anastomosis, stapled anastomosis has shorter operative time and hospitalization and has similar leak and stricture rates. The two methods are safe, but the selection must be based on the experience of the surgeon, the anatomy of the patient, and the conditions during surgery.