End-to-end versus end-to-side esophagogastrostomy after esophageal resection: a prospective cohort study

Alsadeq, Mohamed A.A.; El Fiky, Khaled A.; Elhefny, Amr M.M.; Hamed, Mohammed A.; El-Din Abd El Moneam, Ayman H.

doi:10.4103/ejs.ejs_307_21

End-to-end versus end-to-side esophagogastrostomy after esophageal resection: a prospective cohort study

Authors

Abstract

Background
Several medical and surgical complications arise from esophagectomy including cardiopulmonary complications and anastomotic leaks. Several techniques have been adapted to prevent these complications for better postoperative morbidity and mortality. However, there is no international standardized guideline for the diagnosis and management of anastomotic leaks.
Aim
We aim to compare end-to-end (ETE) anastomosis and end-to-side (ETS) anastomosis regarding postoperative complications mainly anastomotic leakage and stricture, operative time, and hospital stay.
Patients and methods
A prospective cohort for patients undergoing esophagectomy with either ETE anastomosis or ETS anastomosis from October 2018 to March 2020 and follow-up for 18 months.
Results
A total of 30 patients were included, 15 patients in each group. A significant anastomotic leakage (=0.006) is detected in the ETS group compared with the ETE group. No significant difference (=0.68) is detected between ETE and ETS anastomoses regarding postoperative morbidity and mortality. There was no significant difference between two types of anastomosis regarding operative time (ETE vs. ETS, 351.6 ± 2.68 vs. 331.6 ± 4.3, =0.14). The average stay in hospital (days) shows no significant difference between both types of anastomosis. Postoperative stricture shows no significant difference between ETE and ETS anastomosis during 6, 12, and 18 months of follow-up. However, ETS anastomosis had a higher rate than ETE anastomosis of postoperative stricture at the first month due to postoperative edema.
Conclusion
Postoperative leakage and stricture are still the most dreaded complications of esophagectomy. Numerous techniques have been used to overcome these complications. Several randomized clinical trials are needed to study these techniques. In our study, ETE anastomosis had a lower leakage rate compared with ETS anastomosis.

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