[Prevention of anastomotic leakage in esophagogastroplasty (anatomical, experimental and clinical study)]

Anastomotic leakage after esophagogastroplasty is a severe complication attributed to insufficient conduit length and ischemia of its proximal segment. A method combining graft lengthening and perfusion improvement without microsurgical intervention is needed.

A translational study was performed: right gastroepiploic artery (RGEA) angiography (n=20), anatomical seromyotomy study (n=23), experiments in rabbits (n=20) and pigs (n=10). Clinical phase included two independent observations: intraoperative laser Doppler flowmetry (LDF) in 22 patients with standard reconstruction (descriptive analysis of patients not included in comparative study) and comparative study of 84 patients (seromyotomy with ligation of 2-3 gastric branches of RGEA, n=34; control, n=50). Microcirculation (M, SO₂), conduit elongation, complication rate and mortality were assessed.

Anastomosis between gastroepiploic arteries was absent in 50% of cases. Seromyotomy elongated conduit by 8.8±3.5 cm (r=-0.85 between baseline length and elongation). Experimentally, technique increased proximal perfusion (p<0.01). A 31.6% perfusion decrease in anastomotic zone was detected in 22 patients (p<0.001). In comparative study, perfusion in the study group exceeded the control group by 72% (p=2.8·10^-8). Proportion of complication-free patients increased from 8% to 35% (p=0.0036; NNT=4), pneumonia rate decreased from 24% to 6% (p=0.037), and mortality decreased from 14% to 0% (p=0.038). A trend towards lower leakage rate (14%→3%, p=0.135) was observed with 52% power.

Seromyotomy with ligation of gastric branches of RGEA is a pathogenetically reasonable method for prevention of ischemic complications, increasing conduit length and improving microcirculation without microsurgical intervention.