Ann Thorac Surg 2007;83:2259-2260
© 2007 The Society of Thoracic Surgeons
Correspondence
Use of Pedicled Omentum and Endostaplers in Esophagogastric Anastomosis
Nurettin Karaoglanoglu, MD1,
Atila Turyilmaz, MD2,
Atilla Eroglu, MD2
1 Department of Thoracic Surgery, Ataturk Training and Research Hospital for Chest Disease and Chest Surgery, Ankara, Turkey
2 Department of Thoracic Surgery, Faculty of Medicine, Ataturk University, Medical Faculty, Erzurum, 25240 Turkey
(Email: nkaraoglanoglu{at}hotmail.com; atilat{at}atauni.edu.tr; atilaeroglu{at}hotmail.com).
To the Editor:
We read with interest the article by Bhat and colleagues [1] on the use of pedicled omentum in esophagogastric anastomosis. They are suggesting that the pedicled omental transposition for reinforcing the anastomotic suture line reduces the incidence of leakage after esophagogastrectomy for esophageal carcinoma. All anastomosis in this study were hand sewn in a single layer of silk. We must congratulate Bhat and colleagues for the excellent work and adding some valuable guidelines on preventing anastomotic leak after esophagectomy.
We have used pedicled omental flap in esophagogastric anastomosis for prevention of anastomotic leak for 6 years. From February 2000 through September 2006, 132 patients underwent an Ivor-Levis type transthoracic esophagogastrectomy with wrapping of the pedicled omentum around the esophagogastric anastomosis at our institution. All 132 patients had their esophagectomy carried out for malignancy. All anastomoses were performed using a stapled technique. Two patients (1.5%) were identified as having a clinically significant anastomotic leak in the postoperative period. One (50%) of these patients died.
Numerous reports on different aspects and different variations on anastomotic techniques have been published within the last few decades. Anastomosis can be handmade, stapled or semimechanical. As to the hand sewn anastomosis, many technical details (eg, running vs interrupted sutures, absorbable or nonabsorbable, one or two layer sutures, knots within or outside the lumen) have been debated. It is believed that the use of endostaplers with three rows of staplers at each side of the anastomosis decreases the incidence of leaks. In our own experience with 132 resections for carcinomas, the overall incidence of anastomotic leaks was 1.5%; all anastomoses were performed using a stapled technique and pedicled omentum.
We agree with Bhat and colleagues [1] that the pedicled omental transposition reduces the incidence of leakage after esophagogastrectomy. According to our clinical experiences the use of pedicled omentum and endostaplers in esophagogastric anastomosis significantly reduces the incidence of anastomotic leak after esophagogastrectomy for carcinoma of the esophagus.
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References
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- Bhat MA, Dar MA, Lone GN, Dar MA. Use of pedicled omentum in esophagogastric anastomosis for prevention of anastomotic leak Ann Thorac Surg 2006;82:1857-1862.[Abstract/Free Full Text]
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