A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy: the circular-stapled anastomosis with the trans-oral anvil

Guilherme M. Campos, David Jablons, Lisa M Brown, René M. Ramirez, Charlotte Rabl, Pierre Theodore

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Objectives: In expert hands, the intrathoracic oesophago-gastric anastamosis usually provides a low rate of strictures and leaks. However, anastomoses can be technically challenging and time consuming when minimally invasive techniques are used. We present our preliminary results of a standardised 25 mm/4.8 mm circular-stapled anastomosis using a trans-orally placed anvil. Materials and methods: We evaluated a prospective cohort of 37 consecutive patients offered minimally invasive Ivor Lewis oesophagectomy at a tertiary referral centre. The oesophago-gastric anastomosis was created using a 25-mm anvil (Orvil, Autosuture, Norwalk, CT, USA) passed trans-orally, in a tilted position, and connected to a 90-cm long polyvinyl chloride delivery tube through an opening in the oesophageal stump. The anastomosis was completed by joining the anvil to a circular stapler (end-to-end anastomosis stapler (EEA XL) 25 mm with 4.8-mm staples, Autosuture, Norwalk, CT, USA) inserted into the gastric conduit. Primary outcomes were leak and stricture rates. Results: Thirty-seven patients (mean age 65 years) with distal oesophageal adenocarcinoma (n = 29), squamous cell cancer (n = 5) or high-grade dysplasia in Barrett's oesophagus (n = 3) underwent an Ivor Lewis oesophagectomy between October 2007 and August 2009. The abdominal portion was operated laparoscopically in 30 patients (81.1%). The thoracic portion was done using a muscle-sparing mini-thoracotomy in 23 patients (62.2%) and thoracoscopic techniques in 14 patients (37.8%). There were no intra-operative technical failures of the anastomosis or deaths. Five patients had strictures (13.5%) and all were successfully treated with endoscopic dilations. One patient had an anastomotic leak (2.7%) that was successfully treated by re-operation and endoscopic stenting of the anastomosis. Discussion: The circular-stapled anastomosis with the trans-oral anvil allows for an efficient, safe and reproducible anastomosis. This straightforward technique is particularly suited to the completely minimally invasive Ivor Lewis oesophagectomy.

Original languageEnglish (US)
Pages (from-to)1421-1426
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume37
Issue number6
DOIs
StatePublished - Jun 2010

Fingerprint

Esophagectomy
Stomach
Pathologic Constriction
Squamous Cell Neoplasms
Anastomotic Leak
Barrett Esophagus
Thoracotomy
Polyvinyl Chloride
Tertiary Care Centers
Dilatation
Adenocarcinoma
Thorax
Hand
Muscles

Keywords

  • Anastomose
  • Complications
  • Minimally invasive
  • Oesophageal cancer
  • Oesophagectomy
  • Stapler

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy : the circular-stapled anastomosis with the trans-oral anvil. / Campos, Guilherme M.; Jablons, David; Brown, Lisa M; Ramirez, René M.; Rabl, Charlotte; Theodore, Pierre.

In: European Journal of Cardio-thoracic Surgery, Vol. 37, No. 6, 06.2010, p. 1421-1426.

Research output: Contribution to journalArticle

Campos, Guilherme M. ; Jablons, David ; Brown, Lisa M ; Ramirez, René M. ; Rabl, Charlotte ; Theodore, Pierre. / A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy : the circular-stapled anastomosis with the trans-oral anvil. In: European Journal of Cardio-thoracic Surgery. 2010 ; Vol. 37, No. 6. pp. 1421-1426.
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