COMPARISION BETWEEN STAPLED ANASTOMOSIS AND HAND SEWN FOR RESTORATION OF GI CONTINUITY IN GASTROESOPHAGEAL JUNCTION MALAGNANCIES

BACKGRUOND: Tumors of the gastroesophageal junction (-GEJ) are classified as gastric cancers, however their natural behavior and their therapeutic modalities are very much similar to the tumors of the esophagus. Radical surgical resection alone is the only established curative treatment of cancers of the esophagus and gastric cardia.6-8 only suplemended by chemoradiation. Radical resection of gastroesophageal junction cancers with adequate proximal and distal margins and restoration of esophagogastric/esophagojejunal anastomsis is the main aim of surgical treatment, however restoration of gastro intestinal continuity by means of conventional suturing technique sometimes proves technically challenging and circular stapling devices have been found to be very safe and efficient and technically easy alternative to hand sewn suturing technique in these cases. MATERIALS AND METHODS: From March 2010 to Feberuary 2012 a prospective randomized compartive study entitled “Comparision Between Stapled Anastomosis And Hand Sewn Anastomsis in Gastroesophageal Jnction Cancers patients divided randomly into two groups was conducted in Post Gradute Department Of General Surgery Government Medical College Srinagar.All the patients entitled for the study belonged to Seiwert Class 2 and 3. 62 patients were randomly divided into two groups , Group A and Group B ,31 in each group. Among the 31 patients in Group A ,total gastrectomy was done in 14 patients and proximal gastrectomy was done in 17 patients were as 31 patients in Group B total gastrectomy was done in 13 patients and proximal gastrectomy was done 18 patients. Restoration of gastrointestinal continuity was achieved by stapled technique in group A patients and hand sewn technique in groupB patients.All the patients entitled to our study received postoperative chemoradiation as per Macdonald,s regimen. RESULTS: Variables analysed were ,mortality, anastomtic stricture formation ,anastomtic leak,recurrence at one year , mean operating time,mean duration of hosipital stay. Two patients in postoperative period died among 31 patients in group A one due to anastomotic leak and one due to postoperative respiratory complications and one patient died in group B due to anastomtic leak.Anastomotic leak was seen in 7(22.5%) patients in Group A and 5 (16.1%)patients in Group B , recurrence within one year was seen in 5 (16.1%0patients in groupA and 6(19.3%) patients in group B.Anastomtic stricture formation was seen in 6 (19.3%)patients stapled group and 2 patients( 6.4%) in hand sewn group . Mean operating time was 130 ±15 minutes in group A with proximal gastrectomy and 160 ±20 minutes in group A patients with total gastrectomy where as it was 160±20 minutes in group B patients with proximal gastrectomy and 180±15 minutes in group B patients with total gastrectomy.Mean duration of postoperative hosipital stay was 9 days in both groups . CONCLUSION: This study showed that stapled anastomsis is very efficient ,safe ,technically easy and less time consuming technique for restoration of gastrointestinal continuity in Gastroesophageal junction malagnanciesjunction . Thus Stapled anastomosis in restoration of gastrointestinal continuity in Gastroesophageal junction malagnancies can be done with almost same results of morbidity and mortatlity as hand sewn anastomsis and in cases where anastomosis is techniquely very difficult and restoration of gastro-intestinal continuity is difficult to achieve with hand sewn technique.