title: Clinical application of mucosal valve technique for anastomosis during esophagogastrostomy.
abstract: BACKGROUND
  The study aims to compare the efficacy in prevention of anastomotic complications using layer-to-layer mucosal valve technique versus circular stapled technique for esophagogastric intrathoracic anastomosis after resection for esophageal and gastric cardiac carcinoma.
  
  
  METHODS
  From January 2005 to December 2010, 136 patients received layer-to-layer mucosal valve technique (LM group), 219 received circular stapled anastomosis (CS group) after curative intent resection for esophageal and gastric cardiac carcinoma. The technique details were reported and the clinical results were analyzed.
  
  
  RESULTS
  The two groups were comparable on clinical baseline characteristics. The average duration of operation was longer with LM technique by 16 min, but without statistical significance (P = 0.073). There was no anastomotic leakage in the LM group, while in the CS group, leakage occurred in seven patients (3.2 %, P = 0.047). Both the incidence and grade of postoperative dysphagia were significantly lower in the LM group (P < 0.05). Significantly fewer patients experienced stricture after LM technique (3.8 %) compared with CS anastomosis (18.2 %, P < 0.001). CS anastomosis was associated with a significantly higher incidence of persistent stricture requiring more dilatation (P < 0.001). Symptoms of reflux were better controlled by LM technique; 82.7 % of patients were asymptomatic with respect to reflux compared to 58.9 % in the CS group, P < 0.001. And there was a significant reduction in the incidence of esophagitis in remnant esophagus in the LM group (P = 0.001).
  
  
  CONCLUSIONS
  The layered mucosal valve anastomosis could significantly diminish the incidence of anastomotic complications and could be used as an alternative for esophagogastric anastomosis after resection of esophageal and gastric cardiac carcinoma.
authors.affiliation: Gansu Provincial Key Laboratory of Digestive System Tumors, Lanzhou University Second Hospital, Lanzhou University Second Clinical Medical College, 82 Cuiyingmen, Chengguan District, Lanzhou, 730030, People's Republic of China.
authors.forename: Bin
authors.initials: B
authors.lastname: Li
authors.forename: Yu-Min
authors.initials: YM
authors.lastname: Li
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Zhang
authors.forename: Yun-Feng
authors.initials: YF
authors.lastname: Su
authors.forename: Cheng
authors.initials: C
authors.lastname: Wang
authors.forename: Zhi-Qiang
authors.initials: ZQ
authors.lastname: Wang
authors.forename: Yun-Jiu
authors.initials: YJ
authors.lastname: Gou
authors.forename: Tie-Niu
authors.initials: TN
authors.lastname: Song
authors.forename: Jian-Bao
authors.initials: JB
authors.lastname: Yang
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D057868:Anastomotic Leak / Q000517:prevention & control; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D002299:Cardia; D016099:Endoscopy, Gastrointestinal; D004938:Esophageal Neoplasms / Q000601:surgery*; D004946:Esophagostomy / Q000379:methods*; D005260:Female; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000601:surgery*; D013536:Suture Techniques