Ohsawa Manato, Hamai Yoichi, Emi Manabu, Tanabe Kazuaki, Okada Morihito
Department of Surgical Oncology, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan.
Department of Gastroenterological and Transplant Surgery, Hiroshima University, 1-2-3-Kasumi, Minami-ku, Hiroshima City, Hiroshima 734-8551, Japan.
Int J Surg Case Rep. 2020;67:102-105. doi: 10.1016/j.ijscr.2020.01.026. Epub 2020 Jan 27.
An anti-reflux anastomosis "double-flap technique" was recently used to resolve severe reflux esophagitis after intrathoracic esophagogastrostomy performed following proximal gastrectomy and lower esophagectomy, for esophagogastric junction (EGJ) cancer. We describe thoracoscopic reconstruction procedure performed by using the "double-flap" technique, which involves the creation of seromuscular flap under direct vision. This case report aimed to report the usefulness of this intrathoracic anastomosis procedure, as it may be difficult to perform double-flap technique with intraperitoneal manipulation in EGJ cancer cases.
A 58-year-old man was diagnosed with Siewert type II EGJ cancer. We performed laparoscopic proximal gastrectomy, lower esophagectomy, and thoracoscopic esophagogastrostomy using the anti-reflux double-flap technique in the prone position. This was achieved after careful dissection in the plane between the muscular and submucosal layers prior to replacing the remnant stomach into the abdominal cavity. The postoperative course was uneventful, with no symptoms of esophageal reflux after 21 months of surgery, even without medications.
This procedure offers the advantage of minimal invasiveness and ensures adequate surgical margins when lower esophageal incisions are required. This minimally invasive procedure achieves anastomosis using the complete hand-sewn method to prevent reflux, under a good surgical field of view for dissection of the lower esophagus and mediastinal lymph nodes.
This procedure is very useful due to its minimal invasiveness, ease of thoracic procedure, and prevention of reflux in patients with EGJ cancer. To our knowledge, this is the first report of thoracoscopic esophagogastrostomy performed using the double-flap technique for EGJ cancer.
一种抗反流吻合“双瓣技术”最近被用于解决近端胃切除和食管下段切除术后行胸内食管胃吻合术治疗食管胃交界（EGJ）癌后出现的严重反流性食管炎。我们描述了采用“双瓣”技术进行的胸腔镜重建手术，该技术需要在直视下制作浆肌瓣。本病例报告旨在报道这种胸内吻合手术的实用性，因为在EGJ癌病例中，经腹腔操作实施双瓣技术可能存在困难。
一名58岁男性被诊断为Siewert II型EGJ癌。我们采用抗反流双瓣技术在俯卧位下进行了腹腔镜近端胃切除术、食管下段切除术和胸腔镜食管胃吻合术。这是在将残胃放回腹腔之前，在肌层和黏膜下层之间的平面仔细分离后实现的。术后过程顺利，术后21个月即使未用药也无食管反流症状。
该手术具有微创的优点，并且在需要进行食管下段切口时能确保足够的手术切缘。这种微创手术在良好的手术视野下，采用全手工缝合方法进行吻合以防止反流，便于对食管下段和纵隔淋巴结进行解剖。
该手术因其微创性、易于进行胸腔手术以及能预防EGJ癌患者的反流而非常有用。据我们所知，这是首例使用双瓣技术对EGJ癌进行胸腔镜食管胃吻合术的报告。
