Brief Article
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World J Gastroenterol. Dec 7, 2010; 16(45): 5722-5726
Published online Dec 7, 2010. doi: 10.3748/wjg.v16.i45.5722
Esophagogastric anastomosis with invagination into stomach: New technique to reduce fistula formation
Alexandre Cruz Henriques, Carlos Alberto Godinho, Roberto Saad Jr, Daniel Reis Waisberg, Aline Biral Zanon, Manlio Basilio Speranzini, Jaques Waisberg
Alexandre Cruz Henriques, Carlos Alberto Godinho, Roberto Saad Jr, Daniel Reis Waisberg, Aline Biral Zanon, Manlio Basilio Speranzini, Jaques Waisberg, Department of Surgery, University Hospital, ABC Medical School, Santo André, São Paulo, 09060-870, Brazil
Author contributions: Henriques AC and Waisberg J provided the study conception and design; Godinho CA, Zanon AB and Waisberg DR performed the acquisition of data; Henriques AC, Waisberg J and Saad Jr R performed the analysis and interpretation of data; Henriques AC, Waisberg DR and Zanon AB drafted the manuscript; Waisberg J and Speranzini MB critically revised the manuscript.
Supported by ABC Medical School Scientific Project Grant
Correspondence to: Dr. Jaques Waisberg, Department of Surgery, University Hospital, ABC Medical School, Avenida Lauro Gomes 2000, Santo André, São Paulo, 09060-870, Brazil. jaqueswaisberg@uol.com.br
Telephone: +55-11-82560018 Fax: +55-11-55738854
Received: May 18, 2010
Revised: July 10, 2010
Accepted: July 17, 2010
Published online: December 7, 2010
Abstract

AIM: To present a new technique of cervical esophagogastric anastomosis to reduce the frequency of fistula formation.

METHODS: A group of 31 patients with thoracic and abdominal esophageal cancer underwent cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube. In the region elected for anastomosis, a transverse myotomy of the esophagus was carried out around the entire circumference of the esophagus. Afterwards, a 4-cm long segment of esophagus was invaginated into the stomach and anastomosed to the anterior and the posterior walls.

RESULTS: Postoperative minor complications occurred in 22 (70.9%) patients. Four (12.9%) patients had serious complications that led to death. The discharge of saliva was at a lower region, while attempting to leave the anastomosis site out of the alimentary transit. Three (9.7%) patients had fistula at the esophagogastric anastomosis, with minimal leakage of air or saliva and with mild clinical repercussions. No patients had esophagogastric fistula with intense saliva leakage from either the cervical incision or the thoracic drain. Fibrotic stenosis of anastomoses occurred in seven (22.6%) patients. All these patients obtained relief from their dysphagia with endoscopic dilatation of the anastomosis.

CONCLUSION: Cervical esophagogastric anastomosis with invagination of the proximal esophageal stump into the stomach tube presented a low rate of esophagogastric fistula with mild clinical repercussions.

Keywords: Esophageal cancer; Esophagectomy; Constriction; Pathologic; Fistula; Gastroplasty