Embedded Three-Layer Esophagogastric Anastomosis Reduces Morbidity and Improves Short-Term Outcomes After Esophagectomy for Cancer Hai-bo Sun, MD, Yin.

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Embedded Three-Layer Esophagogastric Anastomosis Reduces Morbidity and Improves Short-Term Outcomes After Esophagectomy for Cancer Hai-bo Sun, MD, Yin Li, PhD, Xian-ben Liu, MD, Rui-xiang Zhang, MD, Zong-fei Wang, MD, Yan Zheng, PhD, Jian-jun Qin, PhD, Hao- miao Li, MD, Xian-kai Chen, MD, Zhao Wu, MD The Annals of Thoracic Surgery Volume 101, Issue 3, Pages 1131-1138 (March 2016) DOI: 10.1016/j.athoracsur.2015.09.094 Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Embedded three-layer anastomosis. (A) Row of four interrupted horizontal mattress sutures between the muscular layer of the posterior esophageal and the gastric wall. (B) Posterior muscular layer anastomosis. (C) Posterior mucosal layer anastomosis. (D) Anterior mucosal layer anastomosis. (E) The anastomosis and embedding of the redundant gastric tube into the gastric tube cavity. (F) The complete three-layer anastomosis. The Annals of Thoracic Surgery 2016 101, 1131-1138DOI: (10.1016/j.athoracsur.2015.09.094) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Operative photographs of the embedded three-layer anastomosis. (A) Redundant gastric tube excision. (B) Row of continuous sutures of the cutting edge. (C and D) Embedding the redundant gastric tube into the gastric tube cavity. (E) Row of interrupted horizontal mattress sutures between the anterior aspect of the esophageal muscular layer and the gastric seromuscular layer. (F) Completion of the three-layer anastomosis. The Annals of Thoracic Surgery 2016 101, 1131-1138DOI: (10.1016/j.athoracsur.2015.09.094) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Mean and 95% confidence interval of (A) reflux scores and (B) dysphagia scores after esophageal cancer surgery for the conventional group (dotted line) and the embedded group (solid line) during the first postoperative half year of follow-up (higher scores indicate more severe symptoms). The Annals of Thoracic Surgery 2016 101, 1131-1138DOI: (10.1016/j.athoracsur.2015.09.094) Copyright © 2016 The Society of Thoracic Surgeons Terms and Conditions