A study on the effect of thoracic-laparoscopic double purse-string sutures on anastomotic complications after total minimally invasive transthoracic esophagectomy(ttMIE).

The retrospective analysis of the records of 78 patients who underwent ttMIE Ivor-Lewis esophagectomy for esophageal cancer at the Affiliated Cancer Hospital of Nanjing Medical University from Jan. 2018 to Mar. 2022, of which 34 were in the double purse-string suture group and 44 in the single purse-string suture group. The effect of different purse-string sutures on postoperative anastomosis-related complications in patients during intra-thoracic anastomosis was studied. The primary observations are the incidence and severity of the post-operative anastomotic leak, while the secondary observations are surgery-related conditions and other related complications. The severity of post-operative anastomotic complications was classified according to the Clavien-Dindo (C-D) grade.

There was a statistically significant difference (P< 0.05) in the incidence of anastomotic leak and time to a first postoperative meal between the double- and single purse-string suture groups, and no statistically significant difference (P> 0.05) in the length of chest surgery, length of purse-string suture, intraoperative bleeding, ICU length of stay, and postoperative hospital stay. The difference was not statistically significant (P> 0.05) in the incidence of anastomotic stricture, gastroesophageal reflux, and laryngeal regurgitant nerve injury.

The ttMIE intrathoracic double purse-string suture can effectively reduce the risk of anastomotic leak and facilitate early postoperative food intake for patients, which is a safe and feasible technique to modify esophagogastric anastomosis.