A comparative study of manual esophagojejunostomy versus instrumental anastomosis during total laparoscopic esophagogastrectomy for Siewert type Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction
Objective To explore the differences in intraoperative and postoperative outcomes between hand-sewn esophagojejunostomy and instrumental anastomosisin total laparoscopic esophagogastrectomy for Siewert Ⅱ/Ⅲ adenocarcinoma of esophagogastric junction.Methods From January 2021 to December 2023,the relevant clinical data were retrospectively reviewed for 42 patients undergoing total laparoscopic radical resection of Siewert hagojejunostomy and instrumental anastomosis.They were assigned into two groups of manual(n=22)and instrument(n=20)anastomosis based upon different modes of anastomosis.Total operative duration,esophagojejunostomy time,intraoperative volume of blood loss,postoperative complications,length of hospitalization stay and total hospitalization expense were compared between two groups.Results Time of esophagojejunostomy[(25.82±2.79)min vs(31.65±3.03)min,P＜0.001]and total operative duration[(256.18±19.31)min vs(269.65±17.14)min,P＜0.05]were significantly lower in manual anastomosis group than those in instrument anastomosis group.The difference was statistically significant.Average total hospitalization cost of manual anastomosis group was 4,560 yuan lower than that of instrument anastomosis group and the difference was statistically significant(P＜0.001).No significant inter-group differences existed in intraoperative volume of blood loss,initial postoperative ventilation time or postoperative hospitalization stay(all P＞0.05).No significant inter-group difference existed in the incidence of major postoperative complications(22.7％vs 30.0％,P＞0.05).Conclusion Laparoscopic manual esophagojejunostomy is a safe,reliable,accurate and efficient surgical procedure.It may serve as an important supplement to instrument anastomosis since it reduces the use of additional anastomotic instruments and saves medical insurance funds and hospitalization expenses.
Adenocarcinoma of esophagogastric junctionManualInstrumental anastomosisEsophagojejunostomyTotal laparoscopic
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