376. DOUBLE FLAP RECONSTRUCTION (KAMIKAWA TECHNIQUE) AS ANTI-REFLUX MECHANISM AFTER GASTROESOPHAGEAL SURGERY
Cristina Martínez Chicote, Fernando Mingol Navarro, Mireia Navasquillo Tamarit, Carmen Gutiérrez Sánchez, Pablo Guerrero-Antolino, Beatriz Castro Andrés, Nuria García Olmo, Marcos Bruna Esteban, Francisco Javier Vaqué Urbaneja- Gastroenterology
- General Medicine
Abstract
Background
Gastroesophageal reflux is a frequent adverse effect after oncological surgery of the gastroesophageal junction because of the radicality of the intervention and the placement of the anastomosis inside the thoracic cavity. Different surgical techniques have been developed that seek to re-establish this anti-reflux mechanism, such as the double flap reconstruction, first described by Kamikawa, which consists of the creation of a seromuscular flap surrounding the anastomosis.
Methods
Retrospective observational and descriptive study including all patients in whom this technique has been performed from January 2019 to January 2023. Quantitative variables are described as median and range, and qualitative variables as absolute number and percentage. The IBM SPSS Statistics 22 software was used for the descriptive part.
Results
A total of 8 patients were operated. In 2 cases the anastomosis was performed by laparotomy, 1 by laparoscopy, 4 by right thoracoscopy and 1 by left thoracoscopy. Half of the patients had no postoperative complications and the other half had mild ones. Manometry and pHmetry were requested of all patients after 6 months but only performed in 2 due to technical difficulties. In both cases the tests showed no alterations, but one of the patients reported reflux controlled with PPIs. Other suffered from occasional dysphagia and was being treated with periodic endoscopic dilatations.
Conclusions
The double flap reconstructive technique is a useful tool that can be applied to those patients undergoing an aggressive procedure in the gastroesophageal junction in order to restore its valvular mechanism. It can be performed through different approaches that best fit each surgical scenario. It does not bear greater postoperative complications than standard procedures and may prove to be a good option to improve the quality of life of selected patients.