نوع مقاله : مقاله پژوهشی
1 متخصص جراحی عمومی و فلو شیب جراحی قفسه سینه،
2 استاد یار
3 استاد یار دانشگاه علوم پزشکی بابل
4 رزیدنت ارشد جراحی عمومی
عنوان مقاله [English]
ntroduction: Transhiatal esophagectomy and gastric replacement with cervical esophagegastrostomy by stapler or hand sutures is the most common surgical intervention in esophagial cancer. Anastomotic leak and stricture are the main complications. This study performed to compare the complication rate in the two methods of esophagogastric anastomosis with and without partial gastric fonduplication.
Materials and Methods: This prospective clinical trial study was carried out in 2005 – 2007, at Omid and Ghaem Hospitals of Mashhad University of Medical Sciences on sixty patients with distal two third esophageal cancers, who underwent transhiatal esophagectomy. Patients divided into two groups randomly. Esophagogastric anastomosis to the posterior gastric wall was performed with a partial gastric fonduplication in the first group but simple routine anastomosis was done to the posterior gastric wall in the second group. All cases were followed for 6 months and anastomosis leak and stricture were assessed by clinical exams and barium swallow study. Suspected strictures underwent esophagogastroscopy to prove benign stricture. Data analyzed by χ2 test.
Results: In the present study male to female ratio was 36 to 24 and mean age was 53.6±7.4 years. Squamoas cell carcinoma was observed in 76.7% and adenocarcinoma was reported in 22.3%. 77.7% of tumours were located in distal third and 23.35 were in medial third of esophagus. Esophagogastric anastomotic leakage was observed in 2 cases of fonduplication group and 3 cases of simple anastomosis technique, with no significant difference (p=0.64). Benign anastomosis stricture wasn’t reported in any of patients who underwent esophagogastric anastomosis with fonduplication but was observed in 4 cases with simple anastomosis technique, so there was a significant difference between the two groups (p=0.03).
Conclusion: Esophagogastric anastomosis with partial gastric fonduplication decreased benign anastomosis stricture and appropriate leakage rate, so it is suggested as the preferred Esophagogastric anastomosis technique, although further studies are indicated.