Risk Factors for Anastomotic Stricture and Obstructive Symptoms Following Double-Flap Technique Reconstruction After...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Surgical Technique

Background:

• The double-flap technique (DFT) is a common esophagogastrostomy method after proximal gastrectomy (PG).
• Anastomotic stricture and obstructive symptoms are significant concerns after DFT reconstruction, impacting patient quality of life (QOL).

Purpose of the Study:

• To identify risk factors for anastomotic stricture and obstructive symptoms following PG with DFT reconstruction.
• To evaluate the impact of technical factors on postoperative outcomes.

Main Methods:

• A retrospective analysis of 77 patients undergoing DFT reconstruction (2014-2022).
• Evaluation of technical factors, including suturing methods and mucosal detachment.
• Ex vivo intraluminal pressure analysis using pig stomach models.

Main Results:

• Anastomotic stricture occurred in 13% of patients, with esophageal mucosal detachment identified as an independent risk factor (OR: 48).
• Thermal damage during esophageal transection was a potential risk factor for mucosal detachment (OR: 6.63).
• Continuous suturing for esophago-gastric (E-S) fixation increased the risk of moderate/severe obstructive symptoms (OR: 4.50) and intraluminal pressure.

Conclusions:

• Minimizing thermal damage to prevent mucosal detachment may reduce anastomotic stricture rates.
• Interrupted suturing at the E-S fixation site could potentially decrease obstructive symptoms.
• Optimizing DFT reconstruction techniques can improve postoperative outcomes and patient QOL.