Esophageal anastomosis: experience of open surgery and modern possibilities of video endoscopic technologies. A review

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Abstract

The weakest link in laparoscopic gastrectomy is the esophageal anastomosis, the reliability of which, despite the large number of proposed techniques, remains insufficient. The article presents modern methods of intracorporeal esophageal anastomosis, assesses their advantages and disadvantages. Almost all techniques use a single-layered, mostly mechanical, suture. The probability of maintaining the tightness of a single-layered esophageal anastomosis in case of its healing by secondary tension is extremely small. The experience of open surgery has shown that the placement of the terminal esophagus and the first layer of sutures of anastomosis in a serous-muscular sheath, which is formed from the wall of the intestine or stomach using invagination or wrapping methods, provides a greater likelihood of maintaining the tightness of the anastomosis in any type of healing. Expanding indications for the use of these methods in open surgery and developing a technique for intracorporeal esophageal anastomosis with covering the first layer of sutures of anastomosis with the wall of the anastomosed organ seems to be a promising direction that can significantly reduce the incidence of anastomotic leak both in open and laparoscopic surgery.

About the authors

Sergey N. Nered

Blokhin National Medical Research Center of Oncology; Russian Medical Academy of Continuous Professional Education

Author for correspondence.
Email: nered@mail.ru
ORCID iD: 0000-0002-5403-2396

d. sci. (med.)

Russian Federation, Moscow

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2. Fig. 1. Methods of introduction into the esophagus of the circular stapler anvil during the formation of intracorporeal esophageal-intestinal anastomosis (EIA): a – manual method of purse suture and anvil insertion; b – preservation of the posterior esophageal wall during purse suturing; c – Endo-PSI (II) device for purse suture; d – removal of the anvil rod next to the staple suture; e – lift method; f – method of transoral introduction of the anvil (OrVil).

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3. Fig. 2. Intersection of the machine stitch during the formation of the EIA: a – formation of the "ear" when using a circular stapler; b – intersection of the stitches when using linear staplers in the U-shaped EIA.

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4. Fig. 3. Intracorporeal EIA using linear staplers: a – U-shaped; b – EIA using the overlap method (overlap anastomosis).

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5. Fig. 4. Covering the first line of anastomosis sutures with a split seromuscular flap: a – Kamikawa esophageal-gastric anastomoses; b – Leifer EIA.

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6. Fig. 5. Buried EIAs: a – K.N. Tsatsanidi intestinal anastomosis; b – afferent intestine cover; c – EIA by H. Hilarowitz; d – V.I. Kazansky; e – M.Z. Sigal; f – G.V. Bondar; g – M.I. Davydova; h – G.V. Bondar modified by the Blokhin National Medical Research Center of Oncology.

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7. Fig. 6. Buried esophageal-gastric anastomoses: a – invaginated end-to-end and end-to-side types; b – covered by the gastric wall similar to the Nissen fundoplication; c – V.I. Kazansky's method with an intact and resected stomach; d – M.I. Davydov slide anastomosis.

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