بررسي مقايسه اي دو تكنيك آناستوموز گردني از وفاگوگاستروستومي با يا بدون فوندوپليكاسيون نسبي در بيماران مبتلا به سرطان مري

A Comparative Study ofCervical Esophagogastrostomy with or without Partial Funduplication in Esophageal Carcinoma

Transhiatal esophagecromy and gastric replacement with cervical esophagogastrostomy by stapler or hand sutures is the most common surgical intervention in esophagial cancer. Anastomotic leak and stricture are the main complications. This study performed to compare the complication rate in the two methods of esophagogasrric anastomosis with and wi thout partial gastric fondupli cation. Materials and Methods: 11ltS prospective clinical trial study was canied out in 2005 .. 2007, at Ornid and Ghaem Hospitals of Mashhad University of Medical Sciences on sixty patients with distal two third esophageal cancers, who underwent transhlatal esophagectorny. Patients divided into two groups randomly. Esophagogastric anastomosis to the posterio r gastric wall was performed with a partial gastrie fonduplication in the first group but simple routine anastomosis was done [ 0 the posterior gaStI1C wall in the second group. All cases were followed for (i months and anastomosis leak and stricture were assessed by clinical exams and barium swallow study. Suspected strictures underwent esophagogastroscopy to prove benign stricture. Data analyzed by X2 test. Result s: In the present study male to female ratio was 36 to 24 and mean age was 53.6±7.4 years. Squamoas cell carcinoma was observed in 76.7% and adenocarcinoma was reported in 22.3%. 77.7% of tumours were located in distal third and 23.35 were in medial third of esophagus. Esophagogastric anastomotic leakage was observed in 2 cases of fonduplication group and 3 cases of simple anastomosis technique, with no significant difference (p=0.64). Benign anastomosis stricture wasnʹ t reported in any of patients who underwent esophagogastric anastomosis with fonduplication but was observed in 4 cases with simple anastomosis technique. so there was a significant difference between the two groups (p=O.03). Conclusion : Esophagogastric anastomosis with partial gastric Ionduplicaiion decreased benign anastomosis stricture and appropriate leakage rate. so it is suggested as the preferred Esophagogastric anastomosis technique, although further studies are indicated.