Thoracoscopic Intrathoracic Double-Flap Technique for EGJC

Area of Science:

• Minimally invasive surgery
• Surgical oncology
• Gastrointestinal surgery

Background:

• Valvuloplastic esophagogastrostomy using the double-flap technique (DFT) is effective for reflux prevention and has a low anastomotic leakage rate.
• Intrathoracic reconstruction is a safer option when the transhiatal approach is difficult for esophagogastric junction cancer (EGJC).
• Thoracoscopic intrathoracic DFT has been reported in isolated cases, with limited evaluation of its feasibility and reproducibility.

Purpose of the Study:

• To evaluate the technical feasibility and reproducibility of thoracoscopic intrathoracic DFT for mediastinal esophagogastrostomy.
• To assess the safety and efficacy of this technique in a case series.

Main Methods:

• A consecutive six-patient case series of thoracoscopic intrathoracic DFT following laparoscopic proximal gastrectomy and lower esophagectomy.
• Preparation of a seromuscular flap and elevation of the remnant stomach into the thoracic cavity.
• Posterior esophageal wall fixation, 90° rotation, and completion of a full-circumference hand-sewn esophagogastrostomy.

Main Results:

• All procedures were completed thoracoscopically without conversion.
• The median reconstruction time was 78 minutes.
• No anastomosis-related complications were observed.

Conclusions:

• Thoracoscopic intrathoracic DFT is technically feasible and reproducible for mediastinal esophagogastrostomy.
• Standardized exposure with posterior fixation and 90° rotation enables stable suturing.
• This technique supports the safe application of valve-forming reconstruction in the thoracic cavity.