Double-stapling technique for transhiatal distal esophageal resection: Feasibility test in a cadaver model

Abstract Objectives To assess the feasibility of a new surgical technique for the resection of the distal third of the esophagus and/or cardias for neoplasm. Methods This surgical technique consists of two steps: 1 Insertion of the anvil of a common Entero-Enteric-Anastomotic Surgical Circular Stapler (EEATM) without hand-sewn securing. For this purpose we built a stainless steel support bar for the anvil that is thinner than the freespace of a standard linear suturing stapler (TATM). The support bar holds up a push rod that can be adapted to the hooking–unhooking of the anvil. 2 Anchoring the anvil to the proximal esophageal stump by suturing directly the esophagus with the TATM over the support bar, mobile and thus unhooked from the anvil, in order to perform the esophago-enteric anastomosis with the classic circular stapler EEATM (double-stapling). Results We performed our new technique on five cadavers. We did not encounter any difficulty during the procedures. We tested the anastomosis with hydropneumatic assessment without recording any leaks. The esophago–enteric anastomosis was then opened without finding any mechanical defects related to the procedure. Conclusion It can often be very difficult to fashion a safe hand-sewn pouch or a purse string around the anvil of an EEATM during the resection of the distal third of the esophagus or the cardias by a trans-hiatal approach. Moreover, there is no standardized procedure to minimize anastomotic leak. To avoid these mechanical problems we designed this innovative procedure, which is considered to be reproducible without significant training.