A Simple Modification to Facilitate the H Anastomosis: Making the Mucosal Insertion Step Reproducible

H anastomosis is an emerging technique for esophagogastric reconstruction with promising perioperative outcomes thanks to its antileakage and antireflux design. However, inserting the sutured mucosal bridge into the gastric lumen remains technically challenging. Many surgeons attempting to reproduce the procedure find it difficult to understand the original intent and manipulation of the inventor. We propose a simple modification: a monofilament suture is passed beneath the mucosal bridge, then looped and fixed with a Rumel tourniquet, which assists in smoothly drawing the mucosa into the stomach. This modification improves procedural clarity, operability, and reproducibility, which may support broader clinical adoption.