Application value of continuous seromuscular layer sutures in the reinforcement of esophagojejunostomy in total gastrectomy for gastric cancer: a retrospective comparative cohort study

BACKGROUND: The development process of gastrointestinal anastomosis is from complex to simple, from two layers to one layer, from extramucosal anastomosis to seromuscular anastomosis. With the rapid development of anastomosis instruments, the anastomosis process becomes more and more convenient. However, relevant studies have shown that related complications such as anastomotic leakage still occur. This study sought to investigate the feasibility and safety of seromuscular layer sutures in the reinforcement of esophagojejunostomy after open radical total gastrectomy. METHODS: This study retrospectively analyzed patients who underwent Roux-en-Y esophagojejunostomy after open radical total gastrectomy at The Third Department of Surgery, The Fourth Hospital of Hebei Medical University from April 2019 to May 2020. The inclusion criteria of patients were between 18 and 80 years old; pathology confirmed gastric adenocarcinoma; preoperative imaging showed no distant metastasis and did not receive neoadjuvant therapy; no complex infectious diseases; no blood transfusion was performed before operation. A total of 192 patients were included according to the inclusion criteria. They were divided into the following 2 groups based on whether seromuscular layer suturing of the anastomosis was performed: (I) group A (the simple anastomosis group, n=76); (II) and group B (the seromuscular layer suture group, n=116). The baseline data, surgical data and postoperative complications were compared between the two groups. RESULTS: All patients underwent esophagojejunostomy Roux-en-Y anastomosis after open radical total gastrectomy, and no perioperative deaths occurred. There was no significant difference in baseline data between the two groups. Group B had an earlier time to liquid diet than group A (4.23±0.76 vs. 4.57±0.58 days, P<0.001). The incidence of postoperative anastomotic leakage in group B (1.72%) was lower than that in group A (9.21%), and the difference was statistically significant (P=0.03). The incidence of pleural effusion was lower in group B (15.52%) than group A (32.89%), and the difference was statistically significant (P=0.005). CONCLUSIONS: Compared to the simple anastomosis, seromuscular layer sutures after esophagojejunostomy may decrease the rates of postoperative anastomotic leakage and pleural effusion. This suture method is feasible and may provide a new option to increase surgical safety.