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Article: A single-layer, continuous, hand-sewn method for esophageal anastomosis: Prospective evaluation in 218 patients

TitleA single-layer, continuous, hand-sewn method for esophageal anastomosis: Prospective evaluation in 218 patients
Authors
Issue Date2005
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.com
Citation
Archives Of Surgery, 2005, v. 140 n. 1, p. 33-39 How to Cite?
AbstractHypothesis: A 1-layer, continuous technique for esophageal anastomosis after esophagectomy has been in routine use at the University of Hong Kong Medical Centre since 1996. This study aims to document the results of this method and examine factors that may predispose patients to complications associated with esophageal anastomosis. Design: Retrospective study. Setting: University academic surgical center. Patients and Methods: We studied 218 consecutive patients who had an esophageal anastomosis constructed with a 1-layer, continuous technique. Data were prospectively collected. Main Outcome Measures: Morbidity and mortality rates, anastomotic leaks, stricture, and recurrences. Results: Anastomotic leaks affected 7 patients (3.2%), of whom 3 required surgical reexploration and none died. The hospital mortality rate was 0.9% (2 patients), attributed to myocardial infarction and malignancy. Anastomotic strictures developed in 24 patients (11.1%). Multivariate analysis in those with gastric conduits showed that a cervical anastomosis (intrathoracic vs cervical; odds ratio, 0.27; 95% confidence interval, 0.08-0.87; P=.03) and use of the distal stomach (distal stomach vs whole stomach; odds ratio, 5.25; 95% confidence interval, 1.65-16.66; P = .005) were predictive of benign anastomotic stricture formation. Eleven patients (17.5%) who had a cervical anastomosis developed strictures compared with 13 (8.6%) in those who had intrathoracic anastomoses. Strictures developed in 12 patients (7.4%) with a whole stomach conduit and in 9 patients (19.6%) with a distal stomach conduit. Anastomotic recurrence occurred in 8 patients (3.7%); none had a histologically involved resection margin. Conclusion: The single-layer, continuous, hand-sewn technique for esophageal anastomosis is safe and effective. Cervical anastomosis and use of the distal stomach were associated with more benign strictures.
Persistent Identifierhttp://hdl.handle.net/10722/84201
ISSN
2014 Impact Factor: 4.926
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLaw, Sen_HK
dc.contributor.authorSuen, DTKen_HK
dc.contributor.authorWong, KHen_HK
dc.contributor.authorKwok, KFen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T08:50:09Z-
dc.date.available2010-09-06T08:50:09Z-
dc.date.issued2005en_HK
dc.identifier.citationArchives Of Surgery, 2005, v. 140 n. 1, p. 33-39en_HK
dc.identifier.issn0004-0010en_HK
dc.identifier.urihttp://hdl.handle.net/10722/84201-
dc.description.abstractHypothesis: A 1-layer, continuous technique for esophageal anastomosis after esophagectomy has been in routine use at the University of Hong Kong Medical Centre since 1996. This study aims to document the results of this method and examine factors that may predispose patients to complications associated with esophageal anastomosis. Design: Retrospective study. Setting: University academic surgical center. Patients and Methods: We studied 218 consecutive patients who had an esophageal anastomosis constructed with a 1-layer, continuous technique. Data were prospectively collected. Main Outcome Measures: Morbidity and mortality rates, anastomotic leaks, stricture, and recurrences. Results: Anastomotic leaks affected 7 patients (3.2%), of whom 3 required surgical reexploration and none died. The hospital mortality rate was 0.9% (2 patients), attributed to myocardial infarction and malignancy. Anastomotic strictures developed in 24 patients (11.1%). Multivariate analysis in those with gastric conduits showed that a cervical anastomosis (intrathoracic vs cervical; odds ratio, 0.27; 95% confidence interval, 0.08-0.87; P=.03) and use of the distal stomach (distal stomach vs whole stomach; odds ratio, 5.25; 95% confidence interval, 1.65-16.66; P = .005) were predictive of benign anastomotic stricture formation. Eleven patients (17.5%) who had a cervical anastomosis developed strictures compared with 13 (8.6%) in those who had intrathoracic anastomoses. Strictures developed in 12 patients (7.4%) with a whole stomach conduit and in 9 patients (19.6%) with a distal stomach conduit. Anastomotic recurrence occurred in 8 patients (3.7%); none had a histologically involved resection margin. Conclusion: The single-layer, continuous, hand-sewn technique for esophageal anastomosis is safe and effective. Cervical anastomosis and use of the distal stomach were associated with more benign strictures.en_HK
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.comen_HK
dc.relation.ispartofArchives of Surgeryen_HK
dc.titleA single-layer, continuous, hand-sewn method for esophageal anastomosis: Prospective evaluation in 218 patientsen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-0010&volume=140&issue=1&spage=33&epage=39&date=2005&atitle=A+single-layer,+continuous,+hand-sewn+method+for+esophageal+anastomosis+-+prospective+evaluation+in+218+patientsen_HK
dc.identifier.emailLaw, S: slaw@hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityLaw, S=rp00437en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1001/archsurg.140.1.33en_HK
dc.identifier.pmid15655203-
dc.identifier.scopuseid_2-s2.0-12144274261en_HK
dc.identifier.hkuros99975en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-12144274261&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume140en_HK
dc.identifier.issue1en_HK
dc.identifier.spage33en_HK
dc.identifier.epage39en_HK
dc.identifier.isiWOS:000226311900006-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLaw, S=7202241293en_HK
dc.identifier.scopusauthoridSuen, DTK=8876971300en_HK
dc.identifier.scopusauthoridWong, KH=36485841700en_HK
dc.identifier.scopusauthoridKwok, KF=7102194177en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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