The Y-shaped layered antireflux anastomosis in esophagectomy

Anastomotic complications, including anastomotic leakage, stricture, and reflux, remain major sources of morbidity after esophagectomy, yet existing techniques inadequately address this triad of issues.

To describe a novel Y-shaped layered antireflux anastomosis (Y-shaped group) and evaluate its preliminary outcomes compared with conventional circular-stapled anastomosis (O-shaped group).

Retrospective review of a prospectively maintained database from a tertiary referral center, including consecutive patients who underwent thoracolaparoscopic esophagectomy with gastric tube reconstruction between January and December 2025.

Hand-sewn Y-shaped anastomosis versus circular-stapled end-to-side anastomosis.

Among 573 patients (102 Y-shaped, 471 O-shaped), the Y-shaped group was older (66.1 vs 63.0 years; P < .001), had more cN3 disease (P = .006), and had better tumor differentiation (P = .006). Anastomotic leakage (1.0% vs 5.9%; P = .038), stricture (3.9% vs 12.3%; P = .013), dysphagia (4.9% vs 16.8%; P = .002), and symptomatic reflux (8.8% vs 23.1%; P = .001) were significantly lower in the Y-shaped group. Postoperative hospital stay was shorter in the Y-shaped group (11.8 ± 2.98 vs 13.2 ± 7.96 days; P = .003). At 6 months, mean dysphagia scores (14.33 vs 20.92; P < .001) and reflux scores (21.01 vs 31.86; P < .001) on the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Esophageal Cancer Module 18 were significantly lower in the Y-shaped group. The distribution of complication severity according to the Clavien-Dindo classification was comparable between groups (P = .636).

The Y-shaped anastomosis was technically feasible and associated with lower rates of leakage, stricture, dysphagia, and reflux. These findings warrant prospective validation.