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Kuroda S, Choda Y, Otsuka S, et al. Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study). Ann Gastroenterol Surg. 2018;3(1):96-103doi: 10.1002/ags3.12216.
Kuroda, S., Choda, Y., Otsuka, S., Ueyama, S., Tanaka, N., Muraoka, A., Hato, S., Kimura, T., Tanakaya, K., Kikuchi, S., Tanabe, S., Noma, K., Nishizaki, M., Kagawa, S., Shirakawa, Y., Kamikawa, Y., & Fujiwara, T. (2019). Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study). Annals of gastroenterological surgery, 3(1), 96-103. https://doi.org/10.1002/ags3.12216
Kuroda, Shinji, et al. "Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study)." Annals of gastroenterological surgery vol. 3,1 (2019): 96-103. doi: https://doi.org/10.1002/ags3.12216
Kuroda S, Choda Y, Otsuka S, Ueyama S, Tanaka N, Muraoka A, Hato S, Kimura T, Tanakaya K, Kikuchi S, Tanabe S, Noma K, Nishizaki M, Kagawa S, Shirakawa Y, Kamikawa Y, Fujiwara T. Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study). Ann Gastroenterol Surg. 2018 Oct 11;3(1):96-103. doi: 10.1002/ags3.12216. eCollection 2019 Jan. PMID: 30697614; PMCID: PMC6345660.
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Ann Gastroenterol Surg. 2018 Oct 11;3(1):96-103. doi: 10.1002/ags3.12216. eCollection 2019 Jan.

Multicenter retrospective study to evaluate the efficacy and safety of the double-flap technique as antireflux esophagogastrostomy after proximal gastrectomy (rD-FLAP Study).

Annals of gastroenterological surgery

Shinji Kuroda, Yasuhiro Choda, Shinya Otsuka, Satoshi Ueyama, Norimitsu Tanaka, Atsushi Muraoka, Shinji Hato, Toshikazu Kimura, Kohji Tanakaya, Satoru Kikuchi, Shunsuke Tanabe, Kazuhiro Noma, Masahiko Nishizaki, Shunsuke Kagawa, Yasuhiro Shirakawa, Yasuaki Kamikawa, Toshiyoshi Fujiwara

Affiliations

  1. Department of Gastroenterological Surgery Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences Okayama Japan.
  2. Center for Innovative Clinical Medicine Okayama University Hospital Okayama Japan.
  3. Department of Surgery Hiroshima City Hiroshima Citizens Hospital Hiroshima Japan.
  4. Department of Surgery Fukuyama Medical Center Fukuyama Japan.
  5. Department of Surgery Mihara Red Cross Hospital Mihara Japan.
  6. Department of Surgery Kagawa Prefectural Center Hospital Takamatsu Japan.
  7. Department of Surgery Kagawa Rosai Hospital Marugame Japan.
  8. Department of Surgery Shikoku Cancer Center Matsuyama Japan.
  9. Department of Surgery Okayama Saiseikai General Hospital Okayama Japan.
  10. Department of Surgery Iwakuni Clinical Center Iwakuni Japan.
  11. Minimally Invasive Therapy Center Okayama University Hospital Okayama Japan.
  12. Department of Surgery Matsuda Hospital Kurashiki Japan.

PMID: 30697614 PMCID: PMC6345660 DOI: 10.1002/ags3.12216

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,

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

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