Side-to-side stapled intra-thoracic esophagogastric anastomosis reduces the incidence of leaks and stenosis

Trans‐hiatal esophagectomy with a hand‐sewn anastomosis was for 2 decades the preferred approach in our institution for patients with esophageal cancer. In our experience, this anastomotic technique was associated with a 12% leak rate and a 48% rate of stricture requiring dilatation. We sought to determine if a side‐to‐side intra‐thoracic anastomosis was associated with a lower rate of anastomotic stricture and leak. Thirty‐three consecutive patients with distal esophageal cancer or Barrett's esophagus with high grade dysplasia underwent a trans‐thoracic esophagectomy with a side‐to‐side stapled intra‐thoracic anastomosis. The overall morbidity was 27%, with no anastomotic stricture or leaks. One patient died (3%). The median time to the resumption of an oral diet was 7 days (range 5–28), and the median length of stay in hospital was 9 days (range 6–45). Trans‐thoracic esophagectomy with a side‐to‐side stapled anastomosis is safe and it is associated with a very low rate of anastomotic complications. We consider this to be the procedure of choice for patients with distal esophageal cancers.