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J Thorac Cardiovasc Surg 2006;132:1491-1492
© 2006 The American Association for Thoracic Surgery

Brief Communication

Gastric conduit staple line after esophagectomy: To oversew or not?

Judith Boone, MSc, Inne H.M. Borel Rinkes, MD, PhD, Richard van Hillegersberg, MD, PhD*

Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.

Received for publication July 5, 2006; accepted for publication August 8, 2006.

* Address for reprints: Richard van Hillegersberg, MD, PhD, University Medical Center Utrecht, Department of Surgery, G04.228, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands. (Email: r.vanhillegersberg@umcutrecht.nl).

The first 20% of the full text of this article appears below.

After esophagectomy, continuity is frequently restored by means of gastric replacement. The staple line of this gastric conduit is generally oversewn to prevent leakage and erosion of adjacent tissue. This last step is often omitted during minimally invasive esophagectomy (MIE) because technical difficulties make it time consuming.1Go Moreover, there is little evidence that supports the need for oversewing staple lines in gastrointestinal surgery. We describe two major complications that occurred after abandoning oversewing the staple line of the gastric conduit after esophagectomy.

Clinical Summary

Patient 1
A 66-year-old woman with a squamous cell carcinoma of the midesophagus underwent robot-assisted thoracoscopic esophagectomy. Through a laparotomy, the resected specimen and abdominal lymph nodes were removed. By using the GIA-stapler (GIA 80, 3.8 mm; Tyco Healthcare, Norwalk, Conn), a 3-cm-wide gastric conduit was created.2Go The staple line was not oversewn.

On the first postoperative day, the left thoracic drain produced bile. Methylene blue was injected into the nasogastric tube, which . . . [Full Text of this Article]




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