Experiences with reliability and rate of complications in collar or thoracic anastomosis after subtotal esophagectomy
Nürnberger, H.R.; Löhlein, D.
Zentralblatt für Chirurgie 119(4): 233-239
1994
ISSN/ISBN: 0044-409X PMID: 8203174 Document Number: 431220
In the period from 1988-1992 we performed 148 subtotal esophagectomies. In 69% (102 cases) the operation was carried out because of squamous cell carcinomas of the esophagus, in 27% (40 cases) because of adenocarcinomas and in 4% (6 cases) because of other indications. In 97% (143 cases) the passage was reconstructed by means of a tubulized gastric pull-up established by Akiyama and in of a tubulized gastric pull-up established by Akiyama and in 3% (5 cases) by means of a colon interposition, whereby all interponates were pulled up through the posterior mediastinum. The esophago-gastrointestinal anastomosis was performed in 98% (145 cases) by a hand made suture end-to-side. In 2% (3 cases) we performed the anastomosis by a mechanical EEA device. The collar anastomoses (n = 88) on the posterior wall were covered with the remainder of the gastric fundus, the thoracal anastomoses (n = 60) on the anterior wall were secured by means of a plication. Postoperative surgical complications occurred in 22.7% of the collar and in 25.0% of the thoracal anastomoses. Insufficiencies (n = 3) were observed with thoracic anastomoses only 2 of the 3 insufficiencies were lethal. Postoperative paralysis of the n. recurrens, disturbance of swallowing coordination and aspiration occurred in 29.5% of the collar and in 13.4% of the thoracal anastomoses. In contrast to other reports we were able to show that the collar esophago-enteroanastomosis after subtotal esophagectomy is safer than the thoracic anastomoses with regard to anastomotic insufficiencies.