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Kuroda, Shinji Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences ORCID Kakenhi
Choda, Yasuhiro Department of Surgery, Hiroshima City Hiroshima Citizens Hospital
Otsuka, Shinya Department of Surgery, Fukuyama Medical Center
Ueyama, Satoshi Department of Surgery, Mihara Red Cross Hospital
Tanaka, Norimitsu Department of Surgery, Kagawa Prefectural Center Hospital
Muraoka, Atsushi Department of Surgery, Kagawa Rosai Hospital
Hato, Shinji Department of Surgery, Shikoku Cancer Center
Kimura, Toshikazu Department of Surgery, Okayama Saiseikai General Hospital,
Tanakaya, Kohji Department of Surgery, Iwakuni Clinical Center
Kikuchi, Satoru Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Tanabe, Shunsuke Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Noma, Kazuhiro Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Nishizaki, Masahiko Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Kagawa, Shunsuke Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences ORCID Kakenhi
Shirakawa, Yasuhiro Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences
Kamikawa, Yasuaki Department of Surgery, Matsuda Hospital
Fujiwara, Toshiyoshi Department of Gastroenterological Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences ORCID Kakenhi
Abstract
AIM: As a result of the difficulty in effective prevention of gastroesophageal reflux, no standard reconstruction procedure after proximal gastrectomy (PG) has yet been established. The double-flap technique (DFT), or Kamikawa procedure, is an antireflux reconstruction procedure in esophagogastrostomy. The efficacy of DFT has recently been reported in several studies. However, these were all single-center studies with a limited number of cases.
METHODS:
We conducted a multicenter retrospective study in which patients who underwent DFT, irrespective of disease type and reconstruction approach, at each participating institution between 1996 and 2015 were registered. Primary endpoint was incidence of reflux esophagitis at 1-year after surgery, and secondary endpoint was incidence of anastomosis-related complications.
RESULTS:
Of 546 patients who were eligible for this study, 464 patients who had endoscopic examination at 1-year follow up were evaluated for reflux esophagitis. Incidence of reflux esophagitis of all grades was 10.6% and that of grade B or higher was 6.0%. Male gender and anastomosis located in the mediastinum/intra-thorax were independent risk factors for grade B or higher reflux esophagitis (odds ratio [OR]: 4.21, 95% confidence interval [CI]: 1.44-10.9, P = 0.0109). Total incidence of anastomosis-related complications was 7.2%, including leakage in 1.5%, strictures in 5.5% and bleeding in 0.6% of cases. Laparoscopic reconstruction was the only independent risk factor for anastomosis-related complications (OR: 3.93, 95% CI: 1.93-7.80, P = 0.0003).
CONCLUSION:
Double-flap technique might be a feasible option after PG for effective prevention of reflux, although anastomotic stricture is a complication that must be well-prepared for.
Keywords
Kamikawa procedure
antireflux surgery
double‐flap technique
esophagogastrostomy
proximal gastrectomy
Published Date
2018-10-11
Publication Title
Annals of Gastroenterological Surgery
Volume
volume3
Issue
issue1
Publisher
Woley
Start Page
96
End Page
103
ISSN
2475-0328
Content Type
Journal Article
language
英語
OAI-PMH Set
岡山大学
Copyright Holders
© 2018 The Authors
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DOI
Web of Sience KeyUT
Related Url
isVersionOf https://doi.org/10.1002/ags3.12216
License
http://creativecommons.org/licenses/by/4.0/