ObjectiveTo systematically review the impact of side-to-side esophagogastric anastomosis on postoperative anastomostic leak, fibrosis stricture and stroesophageal reflux. MethodsWe searched PubMed, EMbase, The Cochrane Library (Issue 4 2015), Web of Science, CNKI, CBM, Wanfang Database and VIP up to April 2015. Randomized controlled trials involving the complications after side-to-side esophagogastric anastomosis were included. Data were extracted and methodological quality was evaluated by two reviewers independently with a designed extraction form. Then RevMan 5.3 software was used for meta-analysis. ResultsA total of 7 studies involving 684 patients were included. The results of meta-analysis showed that comparing with traditional anastomosis, side-to-side esophagogastric anastomosis could reduce the incidence of fibrosis stricture with RR=0.20 and 95% CI 0.11 to 0.36 (P<0.000 01). There was no statistical difference in incidence of postoperative anasotmostic leaks with RR=0.71 and 95% CI 0.43 to 1.19 (P=0.19) or stroesophageal reflux with RR=0.74 and 95% CI 0.50 to 1.11 (P=0.15) between the two groups. ConclusionComparing with traditional anastomosis, side-to-side esophagogastric anastomosis could reduce the incidences of fibrosis stricture, but there is no statistical difference in anastomostic leak or stroesophageal reflux.
ObjectiveTo describe a technique of side-to-side anastomosis of distal end of sequential vein grafts to small target arteries in coronary artery bypass grafting (CABG) and evaluate its clinical outcomes. MethodsTwelve patients received side-to-side anastomosis at distal end of sequential vein grafts during off-pump CABG in Beijing Anzhen Hospital between October 2012 and March 2013. There were 7 male and 5 female patients with their age of 68.0±3.6 years. To evaluate clinical outcomes of the technique,intraoperative graft blood flow,pulsatility index (PI) and postoperative echocardiography and electrocardiography were examined. ResultsAll the 12 patients successfully received off-pump CABG. Mean graft flow and PI near the distal end anastomosis were 21.1±8.6 ml/min and 2.1±1.0,respectively. Four patients who initially received end-to-side anastomosis underwent revision into side-to-side anastomosis intraoperatively,whose graft flow increased from 2 ml/min,7 ml/min,3 ml/min and 5 ml/min to 10 ml/min,32 ml/min,13 ml/min and 23 ml/min respectively,and whose PI decreased from 18.2,7.1,12.6 and 13.4 to 2.2,0.9,1.8 and 2.8,respectively. Distal end of target arteries were all posterior descending artery. The number of bypass grafts was 4.0±0.7. All the patients were discharged 7-10 days postoperatively. None of the patients had low cardiac output syndrome,malignant arrhythmias or perioperative myocardial infarction in this study. ConclusionSide-to-side anastomosis of distal end of sequential vein grafts to small target arteries in off-pump CABG can produce higher anastomotic patency. Long-term follow-up outcomes of this technique are needed before widely clinical application.
ObjectiveTo explore clinical outcomes of complete mechanical cervical side-to-side esophago-gastric tube anastomosis. MethodsClinical data of 60 patients with esophageal carcinoma (EC)who underwent complete mechanical cervical side-to-side esophago-gastric tube anastomosis in the 153rd Central Hospital of People's Liberation Army from June 2010 to June 2012 were retrospectively analyzed. There were 41 male and 19 female patients with their age of 46-78 (64.2±6.4)years and body weight of 58.6±12.6 kg. There were 39 patients with mid-thoracic EC, 15 patients with lower-thoracic EC, and 6 patients with upper-thoracic EC. There was 1 patient with stageⅠ EC, 32 patients with stage Ⅱ EC, 23 patients with stage Ⅲ EC, and 4 patients with stage Ⅳ EC. Six to 12 months after the operation, all the patients received a survey questionnaire regarding their quantity and quality of food intake as well as gastroesophageal reflux (GER). Fifty-two patients received barium swallow, and 38 patients received gastroscopy and esophageal mucosal biopsy during follow-up. ResultsAll the 60 patients were successfully discharged. Average length of hospital stay was 12.0±2.6 days. Average time for anastomosis was 18.4±3.2 minutes. The incidence of anastomotic leak was 1.7% (1/60). During follow-up, all the 60 patients restored normal food intake, and 14 patients (23.3%)had GER symptoms. Barium swallow showed the average anastomotic diameter of 1.6±0.2 cm (range, 1.2 to 2.2 cm). In 45° trendelenburg position, 31 patients (59.6%)had barium GER, but none of the patients had prolonged barium retention, intrathoracic gastric dilation or disturbed gastric emptying. Gastroscopy of 38 patients showed full anastomotic opening in 24 patients (63.2%)and irregular or semiclosed anastomosis in the other 14 patients (36.8%). Mucosal biopsy under gastroscopy showed chronic inflammation in 18.4% (7/38)patients. ConclusionComplete mechanical cervical side-to-side esophago-gastric tube anastomosis can significantly prevent anastomotic stenosis, leak and intrathoracic stomach symptoms with good clinical outcomes.