Mechanical Stapling Versus Hand-Sewn Technique for End-to-End Anastomosis in Free Jejunal Transfers Following Total Pharyngolaryngectomy.

Abstract

Free jejunal transfers are a standard method for reconstruction after total pharyngolaryngectomy. However, the relative advantages of mechanical stapling compared to hand-sewn techniques for cervical esophagojejunal anastomosis remain unclear. This study aimed to compare postoperative outcomes between these two approaches. Retrospective observational study. Tertiary academic medical center. We performed a retrospective review on 28 patients undergoing free jejunal transfer after total pharyngolaryngectomy between 2014 and 2020. Patients were divided into a mechanical stapler group (n = 12) and a hand-sewn group (n = 16). Outcomes assessed included postoperative complications within 30 days and functional outcomes at or beyond 6 months postoperatively (mechanical stapler: n = 8; hand-sewn: n = 10). We conducted statistical analysis using Fisher's exact and Mann-Whitney U tests. The overall incidence of early postoperative complications was similar between groups. Median operative time was significantly shorter with mechanical stapling (437 vs 540 minutes; P = .002). Functional outcomes, including oral intake and dysphagia symptoms, showed no significant differences. Nasal regurgitation was less frequent with stapling (37.5% vs 90%; P = .043). One anastomotic stricture occurred in the stapler group and we successfully treated it with two sessions of endoscopic balloon dilatation. Mechanical stapling provides comparable functional outcomes to hand-sewn anastomosis while offering the advantage of shorter operative time. These findings support its use as a practical and efficient alternative for cervical esophagojejunal reconstruction following total pharyngolaryngectomy, particularly in settings seeking to optimize both efficiency and safety. umin.ac.jp/ctr Identifier: UMIN000057262. Ⅲ.