Esophageal anastomosis has been performed on 75 patients according to the following principles: (1) No defect of epithelium is allowed (ample epithelium should be preserved). (2) Healing of the wound is between the cut ends, not between adventitia and serosa. (3) Careful attention is paid to direction of suturing and drawing out the needle. (4) The amount of suture material is kept to a minimum. (5) Effective external drainage (if necessary) and intraluminal decompression at the site of anastomosis should be provided. Among 75 patients, only one (1.3%) developed a small fistula at the anastomosis, which was in the cervical region and healed spontaneously. No complaints of dysphagia due to stenosis were observed postoperatively.
Akiyama H. Esophageal Anastomosis. Arch Surg. 1973;107(4):512-514. doi:10.1001/archsurg.1973.01350220002002