STEP 10Endtoside sutured esophagojejunostomy

There are two ways of performing the esophagojejunostomy, suturing either end-to-end or end-to-side. My preference is to use the latter because the end-to-end method carries an increased risk of compromising the circulation at the end of the jejunal loop. It is also easier to match the diameter of esophagus and jejunum in this way. The anastomosis is sutured by hand using a single-layer interrupted suture technique (lift anastomosis).

■ An antimesenteric incision is made in the end of the jejunum, its length corresponding to the diameter of the esophagus. To avoid a blind loop syndrome, the incision is made close (1-2 cm) to the end of the jejunum closed earlier by the staples and oversewn with a non-dissolvable running suture (A).

■ Two corner sutures are inserted and lightly tensioned with Pean forceps. A further stitch is placed midway between the corner stitches on the posterior wall and the back line is completed using full-thickness mattress sutures (B).

STEP 10 (continued)

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