Application of purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis

Objective To explore the safety and clinical efficacy of the purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis.Methods The clinical data of 238 patients with thoracic esophageal carcinoma and 24 patients with carcinoma of the esophagogastric junction received intrathoracic apparatus anastomosis at the Sichuan Provincial People's Hospital from January 2008 to December 2011 were retrospectively analyzed.There were 122 patients received conventional intrathoracic esophagogastric anastomosis (conventional group) and 140 patients received purse string suture stitched in gastric wall of anastomotic stoma before intrathoracic esophagogastric anastomosis (improvement group).The incidences of anastomotic fistula and stenosis of the 2 groups were compared.All data were anlayzed using the t test,chisquare test or Fisher exact probability.Results There were no significant differences in the operation time,intraoperative blood loss,volume of drainage of peritoneal effusion within 24 hours after operation,postoperative hospital stay and postoperative pTNM staging between the 2 groups (t =0.410,0.798,0.634,0.362,x2=0.605,P ＞ 0.05).There were no significant differences in the anastomotic location,stapler type,the weight of stapler esophageal end tissue between the 2 groups (x2 =0.118,0.221,t =0.459,P ＞ 0.05).There were no significant differences in the incidences of pulmonary complication,arrhythmia and mortality between the 2 groups (P ＞ 0.05).The weight of stapler stomach end tissue in the improvement group was significantly greater than that of the conventional group,while the incidences of postoperative anastomotic fistula and stenosis of the improvement group were significantly lower than those of the conventional group (t =13.856,P ＜ 0.05).Conclusion The purse string suture stitched in gastric wall of anastomotic stoma for intrathoracic esophagogastric apparatus anastomosis is simple and safe,and could effectively reduce the rate of anastomotic fistula and stenosis. Key words: Esophageal neoplasms; Neoplasms of the esophagogastric junction; Apparatus anastomosis; Anastomotic fistula; Anastomotic stenosis