[Invaginational antireflux esophageal anastomosis in gastrectomy and proximal resection of the stomach].

Incompetence of esophageal anastomoses and reflux esophagitis are frequent complications occurring after gastrectomy and proximal resection of the stomach. The authors examined 149 persons who underwent operations for carcinoma of the stomach and lower third of the esophagus. In a group of 47 patients who underwent gastrectomy or proximal resection of the stomach with the formation of the ordinary not areflux anastomoses, nine died from incompetence of the sutures. In study of the late-term results gastroduodenoscopy revealed reflux esophagitis in 22 persons. Intraesophageal pH measurement showed values of 2.0 to 3.0. In 20 patients of this group piezo-resonance manometry demonstrated an essential unfavorable feature of the intraluminal pressure gradient--the intraluminal pressure was lower in the esophagus than in the stomach stump anastomosed with it or in the loop of the small intestine. This facilitated the development of reflux esophagitis. The authors developed a method of invagination areflux esophageal anastomosis by the closed techniques with the use of laser. The anastomosis is formed by two continuous sutures of a synthetic absorbable thread with an autraumatic needle. Incompetence of the sutures occurred in two patients. Piezoresonance manometry revealed a zone of increased intraluminal pressure in the region of the esophageal anastomosis. Mild reflux esophagitis was encountered in three patients. The authors recommend a new modification of esophageal anastomosis for surgical practice.