Annals of thoracic surgery short reports · 2025
H Anastomosis: The Ultimate Version of Intussuscepted Anastomosis Technique Used in Alimentary Reconstruction of Esophagectomy.
СтатьяНазвание и аннотация: Перевод в очереди
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Wu Na, Zeng Yu, Zhang Zhenzhong, Xia Qi, Liu Zheng, Yang Wen, Hu Yang
Аннотация
BACKGROUND: Intussuscepted anastomoses in esophagectomy reduce the risks of anastomotic leakage and gastroesophageal reflux, but anastomotic stricture remains a significant concern. This study presents a novel hand-sewn technique, "H anastomosis," designed to minimize stricture formation while preserving antileakage and antireflux functionality.
METHODS: H anastomosis was simulated by using the esophagus and stomach of a Bama pig. The patency and antireflux function were assessed by injecting water into the ex vivo organs to stimulate the flow of food through the anastomotic stoma. Clinical data from 32 patients with esophageal squamous cell carcinoma who underwent minimally invasive esophagectomy with H anastomosis were retrospectively reviewed. Postoperative follow-up included reflux and dysphagia evaluations, as well as 24-hour pH monitoring.
RESULTS: In the animal model, H anastomosis allowed smooth water flow with a maximum antireflux capacity of 90 mm H2O. Clinically, 30 of 32 patients (93.8%) reported no gastroesophageal reflux in the supine position postprandially, as confirmed by normal DeMeester scores. The most common postoperative complication was pneumonia (34.4%), and only 1 patient experienced anastomotic leakage, which healed with conservative management. No significant anastomotic stricture was observed.
CONCLUSIONS: H anastomosis effectively prevents anastomotic leakage and gastroesophageal reflux without causing stricture. Further validation through larger studies is necessary to confirm its long-term efficacy.
METHODS: H anastomosis was simulated by using the esophagus and stomach of a Bama pig. The patency and antireflux function were assessed by injecting water into the ex vivo organs to stimulate the flow of food through the anastomotic stoma. Clinical data from 32 patients with esophageal squamous cell carcinoma who underwent minimally invasive esophagectomy with H anastomosis were retrospectively reviewed. Postoperative follow-up included reflux and dysphagia evaluations, as well as 24-hour pH monitoring.
RESULTS: In the animal model, H anastomosis allowed smooth water flow with a maximum antireflux capacity of 90 mm H2O. Clinically, 30 of 32 patients (93.8%) reported no gastroesophageal reflux in the supine position postprandially, as confirmed by normal DeMeester scores. The most common postoperative complication was pneumonia (34.4%), and only 1 patient experienced anastomotic leakage, which healed with conservative management. No significant anastomotic stricture was observed.
CONCLUSIONS: H anastomosis effectively prevents anastomotic leakage and gastroesophageal reflux without causing stricture. Further validation through larger studies is necessary to confirm its long-term efficacy.