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World Journal of Surgery

Published in:

01-08-2010

Stenosis of Esophago-jejuno Anastomosis After Gastric Surgery

Authors: Takeo Fukagawa, Takuji Gotoda, Ichiro Oda, Yasunori Deguchi, Makoto Saka, Shinji Morita, Hitoshi Katai

Published in: World Journal of Surgery | Issue 8/2010

Abstract

Background

Stenosis of esophago-jejuno anastomosis is one of the postoperative complications of gastric surgery. This complication usually manifests with the symptom of dysphagia and is treated by endoscopic dilatation. No large-scale studies have been conducted to determine the incidence of this complication after surgery.

Methods

The data of a total of 1478 consecutive patients who underwent total, proximal, or completion gastrectomy, including esophago-jejuno anastomosis, between 2000 and 2008 were analyzed retrospectively with a view to determining the incidence of anastomotic stenosis.

Results

Sixty patients (4.1%) developed stenosis of the esophago-jejuno anastomosis which needed to be treated by endoscopic balloon dilatation. The average interval between the surgery and detection of stenosis was 67.4 days (median = 58.0). Multivariate analysis identified female gender, proximal gastrectomy, use of a narrow-sized stapler, and the choice of the stapling device as significant factors influencing the risk of development of anastomotic stenosis.

Conclusion

Esophago-jejuno anastomotic stenosis appears to be a common late postoperative complication after gastric surgery. Endoscopic examination and treatment yielded favorable outcomes in patients complaining of dysphagia after gastric surgery.

Lang H, Piso P, Stukenborg C et al (2000) Management and results of proximal anastomotic leaks in a series of 1114 total gastrectomies for gastric carcinoma. Eur J Surg Oncol 26(2):168–171CrossRefPubMed

Ikeda Y, Minagawa S, Koyanagi N et al (1997) Esophagojejunostomy with manual single layer suturing after a total gastrectomy for gastric cancer. J Surg Oncol 66(2):127–129CrossRefPubMed

Walther BS, Oscarson JE, Graffner HO et al (1986) Esophagojejunostomy with the EEA stapler. Surgery 99(5):598–603PubMed

Kim CB, Suh KW, Moon JI et al (1993) Roux-en-Y end-to-side esophagojejunostomy with stapler after total gastrectomy. Yonsei Med J 34(4):334–339PubMed

Fujimoto S, Takahashi M, Endoh F et al (1991) Stapled or manual suturing in esophagojejunostomy after total gastrectomy: a comparison of outcome in 379 patients. Am J Surg 162(3):256–259CrossRefPubMed

Hyodo M, Hosoya Y, Hirashima Y et al (2007) Minimum leakage rate (0.5%) of stapled esophagojejunostomy with sacrifice of a small part of the jejunum after total gastrectomy in 390 consecutive patients. Dig Surg 24(3):169–172CrossRefPubMed

Isozaki H, Okajima K, Ichinona T et al (1997) Risk factors of esophagojejunal anastomotic leakage after total gastrectomy for gastric cancer. Hepatogastroenterology 44(17):1509–1512PubMed

Nomura S, Sasako M, Katai H et al (2000) Decreasing complication rates with stapled esophagojejunostomy following a learning curve. Gastric Cancer 3(2):97–101CrossRefPubMed

Whitworth PW, Richardson RL, Larson GM (1988) Balloon dilatation of anastomotic strictures. Arch Surg 123(6):759–762PubMed

10.

Kadota T, Hiraide H, Imai J et al (1990) An easy and safe modified method of endoscopic balloon dilation for postgastrectomy anastomotic stricture. Surg Gynecol Obstet 170(5):445–447PubMed

11.

Honkoop P, Siersema PD, Tilanus HW et al (1996) Benign anastomotic strictures after transhiatal esophagectomy and cervical esophagogastrostomy: risk factors and management. J Thorac Cardiovasc Surg 111(6):1141-1146; discussion 1147–1148

12.

Coda S, Oda I, Gotoda T et al (2009) Risk factors for cardiac and pyloric stenosis after endoscopic submucosal dissection, and efficacy of endoscopic balloon dilation treatment. Endoscopy 41(5):421–426CrossRefPubMed

13.

Lee TH, Lee SH, Park JY et al (2009) Primary incisional therapy with a modified method for patients with benign anastomotic esophageal stricture. Gastrointest Endosc 69(6):1029–1033CrossRefPubMed

14.

Takeyoshi I, Ohwada S, Ogawa T et al (2000) Esophageal anastomosis following gastrectomy for gastric cancer: comparison of hand-sewn and stapling technique. Hepatogastroenterology 47(34):1026–1029PubMed

15.

Kataoka M, Masaoka A, Hayashi S et al (1989) Problems associated with the EEA stapling technique for esophagojejunostomy after total gastrectomy. Ann Surg 209(1):99–104CrossRefPubMed

16.

Di Matteo G, Cancrini A Jr, Palazzini G et al (1988) Stapled sutures in digestive tract surgery. Int Surg 73(1):23–28PubMed

17.

Katai H, Sano T, Fukagawa T et al (2003) Prospective study of proximal gastrectomy for early gastric cancer in the upper third of the stomach. Br J Surg 90(7):850–853CrossRefPubMed

Title: Stenosis of Esophago-jejuno Anastomosis After Gastric Surgery
Authors: Takeo Fukagawa
Takuji Gotoda
Ichiro Oda
Yasunori Deguchi
Makoto Saka
Shinji Morita
Hitoshi Katai
Publication date: 01-08-2010
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 8/2010
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-010-0609-y

At a glance: The STEP trials

Springer Medicine

Stenosis of Esophago-jejuno Anastomosis After Gastric Surgery

Abstract

Background

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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