Vol. 5, Issue 2, Part A (2023)

Background: Esophagogastrectomy with Esophagogastrostomy is the mainstay of treatment for operable carcinoma esophagus patient. After gastric fashioning and conduit preparation, esophagogastric anastomosis is done either by hand-sewn or by mechanical circular stapled device but which method has better outcome regarding operating time, anastomotic time, anastomotic leakage, bleeding and pulmonary complications remain still a matter of debate. 
Objective: To compare the early outcome between hand-sewn and stapled esophagogastrostomy for carcinoma esophagus. 
Study design: Comparative cross-sectional study setting and period: Conducted in the Department of Thoracic Surgery, Dhaka Medical College, Hospital, Dhaka from 01st July 2022 to 30th June 2023. Participants: Total 44 patients, who underwent esophagogastrectomy with esophagogastrostomy for carcinoma esophagus, divided in two groups (Group A having 20 hand-sewn patients and Group B having 24 stapled patients) were selected for the study.
Methods: Patients who underwent esophagogastrectomy with esophagogastrostomy for carcinoma esophagus were included in the study. Twenty (20) hand-sewn anastomotic patients and twenty-four (24) stapled anastomotic patients were interviewed by using a structured questionnaire. Epidemiological, clinical and histopathological data of the patients were collected prospectively and analyzed. 
Results: The mean total operating time for hand-sewn group and stapled group were 220.3±20.42 minutes and 205.0±25.70 minutes respectively (p=038). Anastomotic time for hand-sewn group and stapled group were 29.2±3.38 minutes and 19.04±2.73 minutes respectively (p<0.001), per-operative bleeding for hand-sewn group and stapled group were 248.8±71.7 ml and 196.7±59.2 ml respectively, (p=0.012) and pulmonary complications for hand-sewn group and stapled group were 25% vs.4.2% respectively (p=0.045). All these findings were statistically significant. But no statistically significant difference was found in terms of anastomotic leakage (10% vs.4.2% respectively, p=0.445), cardiac complications (35% vs.16.7% respectively, p=0.162), postoperative hospital stay (10% vs.20.8% respectively, p=0.328) and in hospital mortality (5% vs.8.3% respectively, p=0.662).
Conclusion: Although stapled intrathoracic esophagogastric anastomosis had less operating time, anastomotic time, per-operative bleeding and pulmonary complications but regarding anastomotic leakage, hospital stay, cardiac complications and inhospital mortality, both procedures had similar early postoperative outcomes.