Outcome of Hand Sewn Versus Stapled Anastomosis After Transhiatal Esophagectomy

Objective: To compare the outcome of hand sewn versus stapled anastomosis after transhiatal esophagectomy, in terms of operative time, post-operative bleeding, anastomotic leak, stricture formation and cost of operation. Material & Method: This was a randomized controlled trial on 60 patients conducted at North and East Surgical Wards, Mayo Hospital/King Edward Medical University, Lahore. These patients were divided into 2 groups,30 patients undergone stapled method and the other 30 undergone hand sewn method anastomosis. Operative and post- operative complications and outcomes were observed including operative time, postoperative bleeding, anastomosis leakage, stricture formation and cost of operation. Patients selection was based on strict inclusion and exclusion criteria and data was analyzed by using SPSS 20.0. Results: Mean operative time for stapled method (Group A) and hand sewn method (Group B) was 152.00 +/- 12.99 and 184.10 +/- 17.61 minutes. Mean post-operative bleeding for group A and group B was 63.86 +/- 14.56 ml and 128.00 +/- 16.66 ml. In group A only 2(6.67%) patients had anastomotic leak while in group B 8(26.67%) patients had anastomotic leak. In group A only 3(10%) patients had stricture formation while in group B 2(6.67%) patients had stricture formation. Mean cost for group A and group B was 627.00 +/- 43.48 $ and 270.66 +/- 24.76 $ respectively. Except cost all other post-operative parameters like operative time, post-operative bleeding, anastomotic leak and stricture formation were remarkably decreased in patients who underwent stapled method of anastomosis. Conclusion: That stapled anastomosis after transhiatal esophagectomy is more effective than hand sewn anastomosis in term of operative and post-operative outcome, but the cost of operation is high.