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Ann Thorac Surg 1989;48:257-262
© 1989 The Society of Thoracic Surgeons

Articles

Complications after esophagogastrectomy using stapling instruments

Derek D. Muehrcke, MDa,b,1, Raymond J. Donnelly, FRCS(Ed)*,a,b

a General Surgical Service, Massachusetts General Hospital, Boston, Massachusetts, USA
b Department of Thoracic Surgery, Broadgreen Hospital, Liverpool, England

Accepted for publication March 1, 1989.

* Address reprint requests to Dr Donnelly, Broadgreen Hospital, Thomas Drive, Liverpool L14 3LB, England.

We studied 195 patients undergoing esophageal resection using stapling instruments during a period of over 8.5 years. Of these, 178 (91.2%) underwent operation for malignant disease. Operative death occurred in 19 patients (9.7%). Nine (4.6%) postoperative complications, excluding stricture formation, were related to the use of stapling instruments, including two operative deaths (1.0%). Anastomotic leaks and gastrotomy staple line leaks were the most common complications (four each). In 7 patients (3.6%) the circular stapler tore the esophagus; anastomotic leaks subsequently developed in 43% of these patients. After we began oversewing gastrotomy staple lines in 1984, we experienced only one gastrotomy leak due to a technical error. Postoperative stricture formation occurred soon after resection and responded well to one or two dilations. It is better to err on the side of choosing too small a stapling head when performing an esophageal anastomosis because this may reduce the incidence of leaks, and further strictures are easily dealt with.




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