ABSTRACT
The penalties of anastomotic leak from an esophageal anastomosis can be severe. They vary from mortality to a prolonged and traumatic hospital stay or considerable postoperative morbidity, particularly with respect to dysphagia from strictures. This interferes with postoperative quality of life. The causes of anastomotic dehiscence are undoubtedly multi- factorial, with both local and systemic factors playing a role. The anastomosis is started in the posterior midline using a double-ended needled 3-0 monofilament absorbable suture. The knot is thrown intraluminally and midlength so that equal spans of suture are available for each needle. There are two main stapling techniques: circular and linear. The majority of thoracic-stapled anastomoses are performed using the circular stapler, whereas the linear partial-stapled technique is more frequently used in a cervical approach. The uptake of minimally invasive approaches to esophageal resection has been rapid, but benefits have been slow to emerge and there is still no consensus that the outcomes are superior to conventional open surgery.
