311. H ANASTOMOSIS FOR LOW INCIDENCE OF ANASTOMOTIC LEAKAGE, OBSTRUCTION AND GASTROESOPHAGEAL REFLUX

Abstract

Abstract Background End to end intussusception anastomosis is associated with reduced anastomotic leakage for the two layers located at different levels and decreased reflux tends for the intussuscepted structures functioning as a morphological sphincter. Nevertheless, dysphagia often presents due to the anatomy that the inner layer of stomach is larger than its outer layer causing bulge to compress the esophagus below, especially at the sight which gastric wall bends inside. Methods Here we present procedures to perform H Anastomosis which derives from end to end intussusception anastomosis. The critical improvement was the intussuscepted tissue was transformed from the whole layers of esophagus and stomach to the muscular layers of them. The detailed process was shown in the supplementary video which is available at https://1drv.ms/v/s!AmCqlJJZqDPDgzVKV9w4VPd_i72G?e = ubNzUN. Results With removing the intussuscepted seromuscular layer of stomach and muscular layer of esophagus, H anastomosis eliminates the bulge and reduces the thickness of gastric wall covering the esophagus. Postoperative dysphagia is reduced while advantages of intussusception for leakage and reflux control are preserved. These conclusions have been testified by an unpublished prospective cohort study. Conclusion H anastomosis is a novel gastroesophageal anastomosis technique. The preliminary study showed good postoperative outcomes regarding leakage, obstruction and gastroesophageal reflux. Further validation is needed.