anagement of the Cervical sophagogastric Anastomotic Stricture

a g e a e l l lthough the management of a cervical esophagogastric anastomotic leak occurring early after an esophagectomy s generally straightforward, and this complication is seldom ssociated with death, the long-term sequelae of a cervical eak are far from inconsequential. As we and others have bserved, as many as one-third of cervical esophagogastric nastomotic leaks result in an anastomotic stricture as ealing occurs,1,2 and this represents an unsatisfactory outome for an operation that is intended to provide comfortable wallowing. The implications are similar in patients who surive an intrathoracic esophageal anastomotic leak. Our group as previously reported an anastomotic leak rate averaging 3% in nearly 1100 transhiatal esophagectomy patients at he University of Michigan, with nearly half of these patients eveloping subsequent anastomotic strictures,3 consistent ith reported incidences of both cervical anastomotic leak rom 5 to 26% and anastomotic stenosis from 10 to 31%.4-6 n this article, we will discuss our current practice regardng the management of anastomotic strictures following sophagectomy. Conduit ischemia and anastomotic technique are likely the wo major factors that contribute to anastomotic stricture in he absence of salivary fistulae. When performing a cervical sophagogastric anastomosis, our preference is to perform a emimechanical stapled anastomosis7 using an Endo-GIA II 0 mm/3.5 endoscopic linear stapler (Tyco Healthcare, Noralk, CT) to construct the side-to-side esophagogastric anasomosis. The remaining anterior esophagostomy and gastros-