Healing of the cervical esophagogastrostomy.

Reconstruction of the upper digestive tract with the stomach or gastric tube after esophageal resection has proven to be a safe surgical procedure. But dehiscence, leakage, and stricture of the esophagogastrostomy are prevalent and have been reported in 0% to 4%, 5% to 44%, and 7% to 50% of patients respectively. These complication rates exclude esophageal resection for benign diseases and cast doubt in the case of palliation. Many surgeons prefer to resect the esophagus transhiatally with a cervical anastomosis, which circumvents the transthoracic route and avoids possibility of leakage of an intrathoracic anastomosis and its severe consequences, with mortality rates up to 58%. Anastomotic complications occur more frequently, however, after cervical anastomosis compared with the intrathoracic position when the stomach is used as a substitute for the esophagus. Currently, a narrow gastric tube as a neoesophagus is often preferred because of improved gastric emptying in comparison with wide gastric tubes and gastric pull-up. The extra length can be helpful in reaching the neck because a narrow gastric tube makes widening of the upper thorax aperture unnecessary. Despite these advantages, healing of the cervical esophagogastrostomy is often impaired, leading to nonfatal complications such as leakage and stricture formation. Among the factors that might affect anastomotic healing are: surgical technique and material, vascularization of the gastric tube at the level of the anastomosis, diameter of the gastric tube, position of the anastomosis, and reflux of the gastrointestinal contents.