312. H ANASTOMOSIS IN MECKOWN ESOPHAGECTOMY FOR THE REDUCED ANASTOMOTIC LEAKAGE, OBSTRUCTION, AND GASTROESOPHAGEAL REFLUX

Abstract Background Anastomotic Leakage, obstruction, and gastroesophageal reflux are the major conditions to be taken into account during restoration of alimentary transit in Meckown esophagectomy. There are numerous types of anastomosis techniques to achieve different emphases while the optimal one has not been established. The outcomes of the novel H anastomosis and the conventional end to end layered anastomosis were explored in a prospective cohort study. Methods Patients with resectable esophageal cancer underwent Meckown esophagectomy applying end to end layered anastomosis (Conventional group) or H anastomosis (H group) were included. Besides demographic information, the incidence of anastomotic leakage and other major complications were also recorded. The incidence and severity of postoperative digestive symptoms were assessed by a standard questionnaire including Mellow-Pinkas score for dysphagia and reflux frequency at 6 months after surgery. 24 h-PH and impedance surveillance was also performed on patients receiving H anastomosis. Results Of the 122 eligible patients, 88 received end to end layered anastomosis and 34 underwent H anastomosis respectively. 3(3.4%) patients underwent anastomotic leakage in Conventional group and 1(2.9%) in H group (P = 0.897) The incidences of other perioperative complications were comparable between two groups. The H anastomosis was associated with lower incidence of gastroesophageal reflux (17.2% vs 35.8%, P = 0.117) and higher proportion of patients without food solidity limitation (Mellow-Pinkas score = 0) (79.4% versus 69.1% P = 0.305). The DeMeester score extracted from 24 h-PH and impedance surveillance showed the H anastomosis achieved 70% objective reflux free rate. Conclusion H anastomosis is a refinement of intussusception anastomosis and layered anastomosis to preserve the anti-reflux function of one-direction valve formed by intussuscepted tissues, leakage free from the different locations of layers of anastomosis and obstruction prevention from the removal of intussuscepted muscular layer of esophagus and seromuscular layer of stomach. A multicenter randomized trial comparing the outcomes of the H anastomosis and end to end anastomosis is in process to validate these conclusions.