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Kolokotronis et al. Mini-invasive Surg 2021;5:19 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.07

Original Article Open Access

Stapler vs. hand-sewn intrathoracic esophagogastric

anastomosis: which anastomotic method renders
better results?

1
Theodoros Kolokotronis , Michail Galanis 2
1
Clinic for surgery & center for minimal invasive surgery, Evang. Kliniken Essen-Mitte, Essen 45136, Germany.
2
Clinic for general, visceral, thorax, pediatric and endocrine surgery, University Hospital Johannes Wesling Minden, Minden
32429, Germany.
Correspondence to: Dr. Theodoros Kolokotronis, Clinic for surgery & center for minimal invasive surgery, Evang. Kliniken Essen-
Mitte, Henricistr. 92, Essen 45136, Germany. E-mail: fernado13984@yahoo.gr

How to cite this article: Kolokotronis T, Galanis M. Stapler vs. hand-sewn intrathoracic esophagogastric anastomosis: which
anastomotic method renders better results? Mini-invasive Surg 2021;5:19. https://dx.doi.org/10.20517/2574-1225.2021.07

Received: 17 Jan 2021 First Decision: 19 Feb 2021 Revised: 27 Feb 2021 Accepted: 18 Mar 2021 Published: 23 Apr 2021
Academic Editor: Noriyoshi Sawabata Copy Editor: Yue-Yue Zhang Production Editor: Yue-Yue Zhang

Abstract
Aim: We investigated the impact of the anastomotic method in the frame of open abdominothoracic esophageal
resection (hand-sewn vs. stapler anastomosis) in patients with carcinoma submitted to surgery in the University
Clinic of Saarland over a 14-year period.

Methods: In total, 176 patients underwent an abdominothoracic resection with intrathoracic anastomosis and
conventional gastric conduit formation; two groups of patients were analyzed: end-to-end, hand-sewn anastomosis
(Group 1) and end-to-side, circular stapler anastomosis (Group 2). Both groups were compared regarding
anastomotic leaks and strictures, postoperative morbidity, 90-day mortality and survival.

Results: The rates of anastomotic leak and stricture in the stapler group were reduced in comparison to hand-sewn
group, however without reaching statistical significance (8% vs. 13.5%, P = 0.22, and 6% vs. 13.5%, P = 0.1,
respectively). In contrast, the rates of redo surgery (34.1% vs. 8%, P = 0.001) and 90-day mortality (11.9% vs. 2%,
P = 0.02) were significantly higher in the hand-sewn anastomosis group.
Conclusion: The management of anastomotic leak (stent insertion vs. reoperation) combined with the use of
stapler to perform intrathoracic esophagogastric anastomosis improved the postoperative outcome after
abdominothoracic esophageal resection.

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and
indicate if changes were made.

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