447. SAFETY AND FEASIBILITY OF DOUBLE FLAP RECONSTRUCTION (KAMIKAWA TECHNIQUE) AS ANTI-REFLUX MECHANISM AFTER GASTROESOPHAGEAL SURGERY

Abstract Background Gastroesophageal reflux is a common adverse effect after oncological surgery for tumors of the gastroesophageal junction. Some of the reasons are the radicality of the intervention as well as the placement of the anastomosis inside the thoracic cavity, where there is a constant negative pressure. In recent years, multiple methods of digestive tract reconstruction have been developed in order to re-establish this anti-reflux mechanism, such as the double flap reconstruction, first described by Kamikawa, consisting of the creation of a seromuscular flap covering the anastomosis. Methods We designed a retrospective observational and descriptive study including all patients who underwent esophagogastric surgery and Kamikawa doble-flap reconstruction technique from January 2019 to January 2024. The operation conditions, postoperative recovery, postoperative complications (both short and mid-long term), and follow-up data were collected and analyzed. Quantitative variables are described as median and range, and qualitative variables as absolute number and percentage. The IBM SPSS Statistics 22 software was used for the descriptive part. Results We included a total of 10 patients in our series. All of them underwent an esophagogastric resection followed by a doble-flap reconstruction technique. Thoracoscopy in prone position was the approach used in most of the patients. In these cases, the doble flap was performed using the posterior wall of the gastric remnant. Half of the patients had no postoperative complications and the other half, mild ones. Postoperative manometry and pHmetry were only performed in 4 patients due to technical difficulties. In all these cases the tests showed no alterations. Despite this, one patient reported reflux, which was controlled with PPIs. Conclusions The double flap reconstructive technique is a useful tool that can be applied to those patients undergoing an aggressive procedure in the gastroesophageal junction in order to restore its valvular mechanism. It can be performed through different approaches that best fit each surgical scenario. It does not bear greater postoperative complications than standard procedures and may prove to be a good option to improve the quality of life of selected patients.