A Novel Technique of Anti-reflux Esophagogastrostomy Following Left Thoracoabdominal Esophagectomy for Carcinoma of the Esophagogastric Junction.

We developed an anti-reflux technique of intrathoracic esophagogastrostomy, based on the "Kamikawa procedure" or "Double flap technique", which is sometimes used in Japan after open proximal gastrectomy for early upper gastric cancer. We applied this technique to four patients with tumors of the esophagogastric junction. All four patients underwent lower esophagectomy and proximal gastrectomy via a left thoraco-abdominal approach. This procedure includes four steps. Firstly, "double door" seromuscular flaps were created at the anterior wall of the gastric tube. Secondly, the inferior end of the mucosal "window" was opened. Thirdly, suturing was performed between the esophagus and the gastric mucosal "window". Finally, the anastomosis was covered by the seromuscular flaps. No patient experienced post-operative morbidity, or suffered from reflux, even in the Trendelenburg position, dysphagia, or belching. Although this procedure has only been applied to a limited number of patients, we consider that this anastomosis surgical technique is a promising approach to the prevention of reflux after esophagogastrostomy.