Failure of the oesophagogastric anastomosis following minimally invasive oesophagectomy for cicatricial oesophageal strictures

The relevance of the study is conditioned by the need to reduce the risk of oesophagogastric anastomosis failure and improve post-operative outcomes in patients with benign scar lesions of the oesophagus. The purpose of the study was to evaluate the incidence of oesophagogastric anastomosis failure and hospital outcomes after minimally invasive thoraco-laparoscopic extirpation of the oesophagus in patients with benign scar lesions of the oesophagus. A retrospective analysis was carried out of the outcomes of surgical treatment in 102 patients who underwent minimally invasive thoraco-laparoscopic oesophageal resection at a specialist surgical centre, with a cervical oesophagogastric anastomosis created using a 23.5 mm diameter circular stapler. In all cases, vena azygos was preserved. Enteral nutritional support via a jejunostomy was initiated on the second day of the post-operative period. The main analysed indicator was the frequency of anastomosis failure. Additionally, post-operative mortality, the course of the post-operative period, and the need for repeated interventions were evaluated. The failure of oesophagogastric anastomosis was detected in 6 (5.9%) patients. In all cases, the complication was local in nature and was successfully treated with conservative and endoscopic tactics without repeated surgical interventions. The total post-operative mortality was 1.9% (2 cases) and was not associated with anastomosis failure. In 96 (94.1%) patients, the post-operative period was uneventful. In the long-term period, there were no cases of repeated reconstructive surgeries for anastomotic strictures. The results obtained indicate a low incidence of anastomosis failure and an acceptable safety profile of the minimally invasive approach. The practical significance of the study is to confirm the effectiveness of standardised surgical techniques and early enteral support in the prevention of post-operative complications