Oesophagogastrectomy with an anastomosis using linear staplers

Background: Fibrous stricture formation causing dysphagia after oesophagogastrectomy with a circular stapled or sutured anastomosis remains a significant complication, occurring in up to one-third of cases. An anastomosis that avoids this complication would be desirable, given that resection is often performed to palliate dysphagia. We describe a technique of oesophagogastric anastomosis using linear staplers which eliminates the postoperative complication of fibrous stricture formation. Method: A retrospective analysis of 111 consecutive patients who underwent oesophagogastrectomy for neoplasm or benign oesophageal stricture between March 1980 and April 1991 was carried out. Cadaveric models of the anastomosis were constructed and compared to models of circular stapled anastomoses. Results: An anastomosis using linear staplers was used in 111 patients with a leak rate of 2.7%, 30-day and hospital mortality rates of 5.4% and 8.1%, respectively, and no benign stricture formation. In the cadaveric models, the cross-sectional areas of the linear stapled anastomoses were greater than those of the circular stapled anastomoses, suggesting that this is an important factor in preventing fibrous stricture formation. Conclusions: An anastomosis using linear staplers can be performed with a low leak rate, an acceptable operative mortality and no benign stricture formation. We suggest that an anastomosis using linear staplers should be the preferred type of anastomosis in oesophagogastrectomy.