Mechanical Sutures in Operations on the Esophagus & Gastroesophageal Junction

Stapling instruments lend themselves particularly well to esophageal resection and reconstruction, because of their precision and the decrease in tissue trauma, which is associated with the manipulation required to place multiple sutures. This is an important consideration in this fragile organ. Staples can be accurately placed in areas of narrow access, such as the apex of the thorax and the base of the neck. The various anastomoses can be accomplished in a remarkable variety of ways with the linear anastomosing and closing techniques, or with the circular anastomosing instrument. Although the use of mechanical sutures is reliably associated with greater ease and efficiency, compared with manual techniques, in the execution of a given operation, mechanical circular anastomoses are decidedly safer than all other anastomoses in the esophagus. At times, they enable the surgeon to perform an operation that could not have been done safely via manual technique.