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Trauma-related esophageal injuries (TEIs) are a rare but highly lethal condition. The presentation of TEIs is very diverse depending on the location and mechanism of injury (blunt vs. penetrating), as well as the presence or absence of concurrent injuries. The aim of the present systematic review and meta-analysis is to delineate the clinical features impacting TEI management. A systematic review of the Medline, Embase, and web of science databases was undertaken for studies reporting on patients with TEIs. A random effects model was employed in the meta-analysis of aggregated data. Eleven studies, incorporating 4605 patients, were included, with a pooled mortality rate of 19% (95% confidence interval (CI) 13–25%). Penetrating injuries were 34% more likely to occur (RR 0.66, 95% CI 0.49–0.89, P  = 0.01), predominantly in the neck compartment. Surgery was employed in 53% of cases (95% CI 32–73%), with 68% of patients having associated injuries (95% CI 43–94%). In terms of choice of surgical repair technique, primary suture repair was most frequently reported, irrespective of injury location. Postoperative drainage was employed in 27% of the cases and was more common following repair of thoracic esophageal injuries. The estimated dependence on mechanical ventilation was 5.91 days (95% CI 5.1–6.72 days), while the length of stay in the intensive care unit averaged 7.89 days (95% CI 7.14–8.65 days). TEIs are uncommon injuries in trauma patients, associated with considerable mortality and morbidity. Open suture repair of ensuing esophageal defects is by large the most employed approach, while stenting may be indicated in carefully selected cases. [ABSTRACT FROM AUTHOR]

Simple Summary: The textbook outcome (TBO), a multidimensional indicator that reflects an optimal perioperative course, has emerged as a significant prognostic variable in surgical oncology. Our study aimed to assess the occurrence and determinants of TBO following minimally invasive esophagectomy (MIE) for cancer. Within a cohort of 945 patients who underwent MIE at two high-volume centers, TBO was realized in 46.6% of cases, correlating with markedly better overall and disease-free survival. Upon conducting a multivariable analysis, we found that the use of RE (odds ratio (OR) = 1.527; 95% confidence interval (CI) = 1.149–2.028) was associated with a higher likelihood of achieving TBO, whereas a Charlson Comorbidity Index (CCI) of 2 or higher showed an opposite association (CCI2: OR = 0.687, 95% CI = 0.483–0.977; CCI ≥ 3: OR = 0.604, 95% CI = 0.399–0.915). The advantage of RE in attaining a higher rate of TBO, compared to VATE, remained statistically significant after applying inverse probability of treatment weighting, with rates of 53.3% for RE and 42.2% for VATE (p < 0.001). Purpose: The textbook outcome (TBO), a multidimensional indicator that reflects an optimal perioperative course, has emerged as a significant prognostic variable in surgical oncology. Our study aimed to assess the occurrence and determinants of TBO following minimally invasive esophagectomy (MIE) for cancer. Methods: A total of 945 patients who had undergone MIE at two high-volume centers between 2008 and 2022 were analyzed. Multivariable logistic regression analysis was applied to identify the independent predictors of TBO. The potential selection bias associated with choosing between different MIE techniques—namely, robotic esophagectomy (RE) and video-assisted thoracoscopic esophagectomy (VATE)—was addressed by applying inverse probability of treatment weighting (IPTW). Results: TBO was realized in 46.6% of cases (n = 440), correlating with markedly better overall and disease-free survival. Multivariable analysis showed that treatment with RE (odds ratio (OR) = 1.527; 95% confidence interval (CI) = 1.149–2.028) was associated with a higher likelihood of achieving TBO, whereas a Charlson Comorbidity Index (CCI) of 2 or higher showed an opposite association (CCI2: OR = 0.687, 95% CI = 0.483–0.977; CCI ≥ 3: OR = 0.604, 95% CI = 0.399–0.915). The advantage of RE in attaining a higher rate of TBO, compared to VATE, remained statistically significant after applying IPTW, with rates of 53.3% for RE and 42.2% for VATE. Notably, RE contributed to a greater probability of thorough lymph node dissection, resection with negative margins, and the avoidance of major complications. Conclusion: TBO was realized in 46.6% of the patients who underwent MIE for cancer. Patients with a lower CCI and those who received RE were more likely to achieve TBO. [ABSTRACT FROM AUTHOR]

Introduction:  Long-gap esophageal atresia represents a distinct entity among the esophageal atresia spectrum. In many patients, achieving a reasonable anastomosis depends on some millimeters of tissue. We aimed to determine what effect the suturing technique would have on esophageal ex vivo elongation as it may determine the strength of a primary anastomosis.Materials and Methods:  In an analysis of porcine esophagi from animals for slaughter (100-120 days old with a weight of 100-120 kg), we determined esophageal length gain of simple continuous and simple interrupted suture anastomoses subjected to linear traction until linear breaking strength was reached. Statistical power of 80% was ensured based on an a priori power analysis using five specimens per group in a separate exploratory experiment.Results:  The simple continuous suture anastomosis in 15 porcine esophagi (  = 4.47 cm, 95% confidence interval: 4.08-4.74 cm) outperformed the simple interrupted suture anastomosis in another 15 esophagi (  = 3.03 cm, 95% confidence interval: 2.59-3.43 cm) in length gain (Δ = 1.44 cm, 95% confidence interval: 0.87-2.01 cm, p < 0.0001).Conclusion:  Simple continuous anastomoses achieved higher length gain compared with simple interrupted suture anastomoses. This effect warrants an experimental assessment in vivo to assess its potential merits for clinical applicability. [ABSTRACT FROM AUTHOR]

Introduction:  Traction procedures are useful to preserve the child's own esophagus in long-gap forms of esophageal atresia. To date, it remains unclear what suture size or position of the traction sutures is optimal to account for differences in anatomy and to reduce the risk of traction sutures being torn out of the esophageal tissue.Materials and Methods:  Explanted porcine esophagi (from swine aged 100-120 days and weighing 100-120 kg) were divided at the carinal level. Traction sutures were either placed circumferentially or only in the dorsal wall and the breaking strength-circumferential disruption of the muscular layer-was measured. Suture size (USP 4-0 vs. 5-0) was also evaluated in a similar way.Results:  Neither traction suture position did not influence breaking strengths between circumferentially placed traction sutures or those exclusively placed in the dorsal esophageal wall (Δ = 0.47 N, 95% confidence interval: -2.83 to 3.76 N, p = 0.771, n = 11 per group) nor differing suture sizes of USP 4-0 and USP 5-0 (Δ = 1.46 N, 95% confidence interval: -3.2 to 0.28 N, p = 0.0946, n = 9 per group) affected breaking strengths.Conclusion:  Suture size and suture positioning do not affect mechanical stability in Foker's procedure and therefore can be adapted as needed according to patient's anatomy and size. [ABSTRACT FROM AUTHOR]