Antehoracic plastic surgery of the esophagus using the small or large intestine

This operation has been described Kelling (1911), Hacker(1914), pp. WITH. Yudin(1944) In this intervention, an artificial esophagus from the intestine is not carried out retrosternally, as described above, but in front of the sternum in the subcutaneous tunnel.

Indications

1. Chronic empyema after pneumonectomy, leading to the development of chronic broncho-esophageal fistula. In such cases, the retrosternally artificial esophagus is associated with a known risk (the possibility of damage to the pleura, pneumothorax, hematoma).

2.In those cases, when an unsuccessful attempt was made to place an antethoracal artificial esophagus before, uncorrected marks remained on the breast skin.

3.When the superimposed antehoracic artificial esophagus does not function well (recurrent stenosis, reflux, chronic fistula or cancer of the antehoracic colon).

Operation technique

To create an anti-tethoracic artificial esophagus, it is advisable, according to the already described method, to isolate left half of the large intestine and, placing it in the isoperistaltic direction, place it in the tunnel formed by the bougie between the skin and the sternum.

On those rare occasions when left half of the large intestine cannot be used for artificial replacement of the esophagus, for this purpose can be used right half of the large intestine or formed from small intestine loop over Roux.

If the segment of the intestine held under the skin is missing to the proximal end of the esophagus brought out on the neck (this happens more often when using small intestine plastic surgery), then the oral end of the intestine is removed on the skin of the chest wall. A tube is prepared from the skin between the brought out ends of the esophagus and the intestine, which is subsequently connected to the ends of the esophagus and the intestine brought out to the outside, restoring the continuity of the passage of food through the artificial esophagus.

Cutaneous tube prepared according to the method illustrated in rice. 3-155. Between the two ends of the outwardly protruded esophagus and the intestine, a skin flap is formed with a width of approximately four transverse fingers. A bordering skin incision is made under the opening of the intestine and esophagus. The skin flap is dissected from both sides, and then the edges of the prepared flap are sutured together, thus forming a tube. The suture is wire, continuous, capturing only the corium. After the completion of stitching the edges of the tube, the skin defect is closed with a freely transplanted flap from other parts of the body. A synthetic sponge is fixed on top of the dermal tube, which presses the base of this tube somewhat.

Until the full restoration of the antetoracic artificial esophagus, the patient is fed through the gastrostomy tube. The formation of a dermal tube is the last stage of the operation. 7-10 days after the formation of the dermal tube, you can begin to feed the patient through the mouth.

Antethoracic artificial esophagus placement using an insert cutaneous tube should only be used as a last resort. Unusual anti-physiological conditions are created for the skin, which is formed as a tube insert through which food passes. Constant moisture leads to maceration of the skin and other difficulties in normal

In the USA, the most popular is the plastic of the esophagus of the right half of the large intestine. In England, its left half is more often used for these purposes. The large intestine can be moved both in the antiperistaltic direction and isoperistaltic. Some people prefer to carry out the graft from the transverse section or the left half of the colon intrathoracically behind the root of the lung, without attaching particular importance to the peristaltic orientation of the graft.

In a comparative study of the experience of esophageal surgery with the large intestine, it was noted that in 70% of cases the transplant was performed behind the lung root isoperistaltic and in 30% - retrosternally. These were mainly patients with atresia of the esophagus and the stump of its distal segment. The leakage of the proximal anastomosis occurred in 31% of cases, and stricture in this zone developed in 15% of cases among patients who underwent the left part of the colon behind the lung root according to Waterston, and in 41% after retrosternal plastic surgery of the esophagus with the large intestine. In addition, reflux was found in 60% of patients with retrosternal plasty, while with Waterston, this complication was observed in only 18% of patients. Some patients with colonic retrosternal transplant required surgical intervention for ulcers. Analysis of the treatment results allowed us to conclude that plastic surgery of the esophagus from the left half of the large intestine with a transplant behind the lung root according to Waterston is more preferable.

According to another publication analyzing the operations of esophageal plasty with the large intestine, with retrosternal and intrathoracic transplantation, the functional results were the same, but strictures requiring resection developed only with retrosternal plasty.

Complications of plastic surgery of the esophagus by the large intestine

With the retrosternal passage of the right half of the large intestine, a greater number of intraoperative complications of an ischemic nature were observed than with the use of the Waterston method with taking a graft from the transverse section or the left half of the large intestine. These differences can be explained by the fact that in almost 70% of patients, the right half of the large intestine does not have a marginal artery necessary for feeding the graft.

Although in one of the works the failure of the proximal graft anastomosis is noted in only 2% of cases, however, most surgeons report the development of this complication much more often - in 30-33% of patients. If the failure of esophagocolonastomosis can be explained both by technical errors in its imposition, and by a mild degree of ischemia, then the formation of stenosis is undoubtedly associated only with ischemia. Repeated bougienage in such situations is usually ineffective. Therefore, most of the strictures of the anastomosis, the manifestations of which persist for more than 6 months after plastic surgery of the esophagus by the large intestine, clearly require surgical correction. Treatment of anastomotic leak, as well as intervention for esophageal stenosis, is greatly facilitated when the anastomosis is created in the neck. Fortunately, the proximal anastomosis is most often located here, because it is to this level that the burn lesion usually extends proximally and here is the short upper segment of the esophagus with isolated atresia.

Among our patients there was one girl who, at the age of 3 years, underwent plastic surgery of the esophagus with the large intestine for post-burn stenosis. Despite periodically recurrent manifestations of the upper anastomotic stricture, she felt pretty well until the age of 18, when a fistula appeared in her neck. The primary anastomosis was between the cervical esophagus and the terminal ileum. To eliminate the late esophageal-cervical fistula, a sternotomy and an incision along the tenia were made to lengthen the colon segment, which made it possible to remove the terminal ileum and cecum. Then an anastomosis was made between the esophagus and the ascending colon. After this operation, the clinical manifestations disappeared. In the first description of the mentioned method of lengthening for the sternal colonic graft, excision of the tenia was proposed. However, multiple tenia incisions are easier to perform and equally effective.

Reflux into the colon graft after colonic esophageal surgery is usually minimal if the distal esophagus is preserved and the graft is anastomosed to it. It is believed that reflux can also be prevented when a graft from the left colon is connected to the stomach low on the back wall. However, in our opinion, this is not the case. Although it is believed that intra-abdominal localization of a 10 cm segment of the graft effectively prevents reflux, screen-guided x-rays and manometry do not support this assumption.

The creation of a tunnel in the submucosal layer, which provides an antireflux mechanism, effectively prevents reflux into the graft after plastic surgery of the esophagus with the large intestine. As for the Nissen fundoplication around the anterior semicircle of cologastroanastomosis, although it gives good results in an experiment on animals, it does not always prevent reflux in humans.The authors of these experimental works believe that the best method of preventing reflux is to create a coloesophagoanastomosis according to Waterston.

The study of the effect of gastric acid on distal cologastroanastomosis found that the alkaline secretion of the colon tends to neutralize the acid and push it back into the stomach before any complications associated with it arise.However, ulcers of the distal graft, if they occur are the result of exposure to acidic gastric contents. For most patients who develop ulcers, esophageal repair was not supplemented with pyloroplasty or pyloromyotomy, which are intended to improve gastric emptying. The results of this study once again confirm that in cases where cologastroanastomosis is applied, it is necessary to simultaneously produce the stomach.

The study of the motor activity of the colon and other esophageal transplants showed that the large intestine moves the food bolus well, despite the fact that there are no clear signs of coordinated peristalsis. The study of more distant results allows us to say that it does not really matter whether the colon was transplanted iso- or anti-peristaltic. In any case, it quickly loses its ability to move the contents and serves only as a passive conductor for food. There was no difference in terms of the swallowing process when examining 60 patients, two-thirds of whom had an antiperistaltic colonic graft. Reflux from the stomach to the distal parts of the graft is also noted regardless of its peristaltic orientation. But if pyloroplasty was done, then complications were less common. Similar results were obtained by other authors who performed both iso- and anhyperistaltic colonic transplantation in 84 patients.

A functional study of a colonic isotope-labeled milk transplant showed. that in patients who did not have any complaints, the graft was emptied in less than 45 minutes, and gastroesophageal reflux was absent. In patients with certain clinical manifestations, a delay in the emptying of the graft in combination with reflux or only reflux was found. In general, the colonic graft function was assessed as satisfactory.

Late complications of plastic surgery of the esophagus by the large intestine

Among the late complications of esophageal surgery with the large intestine, excessive growth of the graft should be called, which may even lead to its volvulus and obstruction, as described in one of the observations. Ulceration of the graft sometimes contributes to its pericardium. We observed a patient who developed contact osteomyelitis of the sternum as a result of ulceration of the graft; his treatment was extremely difficult.

With regard to our approach to esophageal surgery with the large intestine, we prefer to take the left half of the large intestine and use the Waterston method with the transplant stem behind the pancreas. The distal anastomosis, if possible, is created with the distal segment of the esophagus. In most of these patients, we also perform a Thal fundoplication in order to strengthen the cardiac pulp and prevent gastroesophageal reflux into the graft. But in principle, we prefer to use the replacement of the esophagus with a gastric cylinder, which we pass up through the natural esophageal opening of the diaphragm and anastomose with the proximal (cervical or mediastinal) esophagus, the distal part of which is resected.

Far from all patients, the structural features of the intestine and mesentery make it possible to isolate and mobilize a sufficiently long loop of the small intestine. More suitable is the large intestine, the right or left half of which is easily and without disturbances in the blood supply to the neck and can be connected directly to the esophagus, and, if necessary, even to the pharynx. Better to use the right half with a piece of the ileum. The operation is simple, safe and provides an isoperistaltic position of the graft. The incision is median, extending slightly below the navel. The segment for plastics is selected after a careful study of the main arterial trunks and vascular anastomoses along the entire length of the colon. If it is decided to use its right half, then the peritoneum is dissected under the cecum and in the right lateral canal. Departing from the cecum to the root of the mesentery by 10-12 cm, bandage the trunk a. ileocolica below the division. The nutrition of the mobilized loop is maintained by a. colica media. Then, the vessels of the mesentery ileum terminale are crossed between the clamps and the vessels of the mesentery terminale are tied so as to obtain a free segment 15-20 cm long. By freeing the blind, ascending and hepatic angle of the colon, preserving a. colica media, the graft is moved to the neck under the skin or retrosternally (Fig. 61) so that the segment of the small intestine extends to the left and not to the right, leaving the neck, otherwise patency will be impaired. The transverse intestine is transected at the level of the stomach without ligating the mesenteric vessels. An ileo-transversal anastomosis is applied between the adducting end of the ileum and the outlet of the large intestine end to side or end to end. The central end of the latter (that is, the graft) is connected to the stomach laterally, usually above the existing gastrostomy.

To create the esophagus from the left colon, the parietal peritoneum is dissected in the left lateral canal and the splenic angle is mobilized. Ligate a. colica sinistra and sigmoid arteries below their fork. Then the sigmoid colon is crossed, its leading end is sutured and the loop is brought out to the neck in the antiperistaltic direction. The graft is anastomosed with the stomach as high as possible, in the region of the bottom of the latter. Sometimes, with a burn of the stomach and scarring of its walls, the large intestine is sewn into the healthy part of the duodenum or into the initial loop of the jejunum. The imposition of the esophageal-intestinal anastomosis on the neck is postponed for several days.

The esophagus from the large intestine, especially the retrosternal one, functions well. However, due to the absence of a closing mechanism in the graft from the left half of the large intestine, in some patients, especially in the supine position, regurgitation of food occurs (back throwing it into the mouth). With plastic surgery from the right half of the large intestine with a thin segment, this never happens, since the ileo-cecal (bauginia) valve is included in the artificial esophagus system. Long-term results of colonic esophageal plasty are quite favorable.

Rice. 61. Operations for creating an artificial esophagus from the right half of the large intestine with a segment of the small intestine; view of the completed operation: at the bottom left, the formation of a segment of the transverse colon and small intestine.

The invention relates to medicine, namely to surgery of the esophagus, can be used for plastic surgery of the esophagus with the large intestine after removal of the esophagus and part of the stomach for cicatricial stricture of the esophagus and cicatricial deformity of the stomach due to chemical burns of the esophagus and stomach. Subtotal resection of the esophagus and proximal resection of the stomach with the imposition of three mechanical sutures are performed. The first mechanical suture is placed at an obtuse angle to the greater curvature of the stomach and to the second mechanical suture. In this case, the fornix of the stomach is formed. The third mechanical suture is applied towards the duodenum. At the same time, they retreat from the second mechanical suture, leaving room for anastomosis. The graft is turned so that its mesenteric part is located in the direction of the mechanical suture towards the duodenum. At the aboral end of the colonic graft, a circular incision of the serous-muscular membrane is made in an oblique direction, retreating 10 mm from the side of the mesenteric vessels and 35-40 mm from the side of the antimesenteric edge. Two rows of sutures are applied between the graft and the lesser curvature of the gastric stump, invaginating the distal fragment of the intestine below the circular incision into the lumen of the gastric stump in the form of a duplication. The angle of His is created by fixing the formed fornix of the stomach to the colonic graft. EFFECT: method allows to prevent reflux of stomach contents into a colonic graft and associated complications, to reduce the risk of developing insolvency of gastrointestinal anastomosis sutures, to provide an adequate functional result of the operation. 5 ill.

The invention relates to medicine, namely to surgery of the esophagus, and can be used for plastic surgery of the esophagus by the large intestine after removal of the esophagus and part of the stomach for cicatricial stricture of the esophagus and cicatricial deformity of the stomach due to chemical burns of the esophagus and stomach.

Known methods for the formation of a colonic-gastric anastomosis, performed in colonic plastic of the esophagus, in which anastomosis of the graft with the anterior wall of the unchanged stomach is provided. A number of authors propose to use the antireflux mechanism when imposing a cologastric anastomosis for plastic surgery of the esophagus.

However, these methods do not fully meet the requirements of modern surgical gastroenterology. In the long-term period, the most unfavorable complication is peptic lesions of the graft due to reflux of aggressive contents from the stomach into the artificial esophagus and even into the pharynx. This is due to the absence of areflux properties in the anastomoses or their insufficient severity. Developing stenosis of the anastomotic area and narrowing of the graft above the site of anastomosis are not only a poor functional result of the operation, but also require reconstructive interventions.

A difficult task is the imposition of an anastomosis between the graft and the stump of the stomach during resection of the esophagus and part of the stomach for cicatricial changes due to chemical burns not only of the esophagus, but also of the stomach. The operation of choice is the imposition of the anastomosis with the stump of the stomach, thus creating an "artificial cardia".

The closest (prototype) to the proposed method is a method of forming an anastomosis of an artificial esophagus from the large intestine with a stomach stump, performed by A.F. Chernousov et al. ... The end-to-side kologastroanastomosis is applied to the anterior wall of the antrum in the transverse direction. The transverse anastomosis provides an antireflux effect, in addition, the alkaline environment in the antrum prevents the formation of peptic ulcers of the graft.

The disadvantage of this method is the possibility of reflux of the contents of the stomach due to insufficient antireflux mechanism and the absence of a valve as such and closing of its valves. In some cases, an anastomotic suture failure may occur due to impaired blood supply in the graft. In addition, there is an insufficient functional result of the operation due to the fact that most of the stomach is turned off from the digestion process and there is no natural passage of food throughout the stomach.

The problem solved by this invention is to exclude the pathological effects of reflux of the contents of the stomach on the colonic graft and peptic complications in it, to reduce the risk of developing incompetence of the sutures of the esophageal-colonic anastomosis and to achieve an adequate functional result of the operation.

A new technical result is achieved by using a new method of forming the colorectal anastomosis in esophageal plasty by subtotal resection of the esophagus and proximal resection of the stomach, forming a graft from the left half of the large intestine in an antiperistaltic position, fed by the mesenteric vessels, and resection of the stomach with the imposition of three mechanical sutures , located at an obtuse angle to each other and the greater curvature of the stomach, simulating the fornix of the stomach, rotate the graft along its axis by 90 ° counterclockwise, at the aboral end of the colonic graft, a circular incision of the serous-muscular membrane is made in an oblique direction, stepping back 10 mm from the side mesenteric vessels and 35-40 mm from the side of the antimesenteric edge, two rows of sutures are applied between the graft and the lesser curvature of the gastric stump, invaginating the distal fragment of the intestine below the circular incision into the lumen of the gastric stump in the form of a duplicate, create an angle His by fixing the formed fornix to the colonic graft.

In the scientific, medical and patent literature analyzed by the authors, these distinctive features were not found, and they do not explicitly follow for a specialist from the prior art. This method has been clinically tested at the Research Institute of Gastroenterology, Siberian State Medical University. Thus, this technical solution meets the criteria of the invention "novelty", "inventive step" and "industrially applicable".

The method is carried out as follows.

Verkhnesadinny laparotomy is performed. A sagittal diaphragmokrurotomy is performed, the esophagus is mobilized up to the upper third of the thoracic region. The cervical esophagus is isolated with an oblique incision on the neck on the left, shifting the sternocleidomastoid muscle and the trachea, ligating the esophageal vessels and resecting it. Gastric resection is performed. Form a graft from the left half of the large intestine, cutting out an antiperistaltic graft on the middle colon artery (figure 1).

The formed colonic graft is carried out in the posterior mediastinum and taken out into the wound on the neck. End-to-end coloesophagoanastomosis is applied on the neck.

The aboral edge of the colonic graft is mobilized for 35-40 mm from the side of the antimesenteric edge and 1 cm from the side of the mesenteric edge. A circular incision of the serous-muscular membrane in an oblique direction is applied at the aboral end of the graft, on the mesenteric part passing as close as possible to the resection site, on the antimesenteric part located 35-40 mm from the oral end of the graft, thus forming two valve leaflets and increasing their mobility when the functioning of the valve (figure 2).

Gastric resection is performed using UO-40 devices. For this, the affected part of the organ is removed with the capture of healthy tissues and the apparatuses are applied in such a way as to form the fornix of the stomach, forming an obtuse angle between the greater curvature and the first mechanical suture, as well as between the first and second mechanical sutures. The third mechanical suture is applied towards the duodenum, retreating to a distance of 3 cm from the second mechanical suture, leaving room for the anastomosis (figure 3).

The graft is rotated along its axis by 90 ° counterclockwise so that the mesenteric part of the graft is located in the direction of the mechanical suture towards the duodenum.

Two rows of sutures are applied between the graft and the stomach stump in the area between the second and third mechanical sutures up to 3 cm long, forming an anastomosis. In this case, a valve is formed by invagination of the mobilized portion of the graft into the lumen of the gastric stump in the form of a duplicate by imposing interrupted sutures on the anterior lip of the anastomosis with the capture of the edge of the serous-muscular membrane of the graft, formed as a result of a circular incision, and the serous-muscular membrane of the gastric stump. Serous-muscular sutures are applied, covering the mechanical sutures of the resection lines (Fig. 4).

A gastric vault is created, which is sutured to the colonic graft using 2-4 sutures, thus covering the anastomotic suture and forming an acute angle of His (Figs. 4, 5).

An example of this operation.

Patient Alevtina Yakovlevna Sharova, born in 1940, was admitted to the clinic on 08.01.2002 with a clinical diagnosis:

Main disease: Cicatricial stricture of the cervical esophagus. Condition after a chemical burn of the esophagus (vinegar), 1983. Condition after extirpation of the esophagus, plastic surgery of the gastric stalk from 28.03.01. Imposition of an areflux jejunostomy from 12.04.01 due to necrosis of the cervical region of the graft.

The purpose of the hospitalization was the reconstructive stage of the operation, the closure of the jejunostomy.

Instrumental research data in the preoperative period:

Ultrasound from 9.01.02: Examined a fragment of the cervical esophageal plasty. Outside diameter in various areas from 6.7 mm to 11 mm (the norm for ultrasound parameters for the esophagus). Along the contour of the "esophagus" area with a small size of fibrosis of the surrounding tissues.

FGS from 10.01.02: At the mouth of the esophagus there is a cicatricial circular stricture with a lumen of up to 4 mm.

Conclusion: Cicatricial stricture of the esophagus.

X-ray of the esophagus from 3.10.01: Dysphagia is noted during the passage of water-soluble contrast and barium at level I of physiological narrowing. A small sip of contrast medium takes several swallowing movements. Dysphagia of mixed genesis: there is cicatricial narrowing and psychogenic. No leakage of contrast agent was found.

Conclusion: The condition after plastic surgery of the esophagus with the gastric stem, complicated in the early period by insolvency, in the late period - by cicatricial narrowing.

On 15.01.02, the patient underwent surgery according to the proposed technique with closing the feeding jejunostomy. A sagittal diaphragmokrurotomy was performed from the upper midline laparotomic approach, the esophagus was mobilized up to the upper third of the thoracic region. The cervical esophagus was isolated with an oblique-transverse incision on the neck on the left, shifting the sternocleidomastoid muscle and the trachea, the esophageal vessels were ligated and resected. Additionally, a proximal gastric resection was performed. A graft was formed from the left half of the colon by cutting out an antiperistaltic graft in the middle colon artery.

The formed colonic graft was carried out in the posterior mediastinum and brought out into the wound on the neck. Imposed end-to-end coloesophagoanastomosis on the neck.

Produced mobilization of the aboral edge of the colonic graft for 35-40 mm from the side of the antimesenteric edge and 1 cm from the side of the mesenteric edge. A circular incision of the serous-muscular membrane was applied at the aboral end of the graft in an oblique direction, on the mesenteric part passing as close as possible to the resection site, on the antimesenteric part located 35-40 mm from the oral end of the graft.

The stomach was resected using the UO-40 apparatus. At the same time, the apparatuses were applied in such a way as to form the fornix of the stomach, forming an obtuse angle between the greater curvature and the first mechanical suture, as well as between the first and second mechanical sutures. The third mechanical suture was placed towards the duodenum, retreating at a distance of up to 3 cm from the second mechanical suture, leaving room for the anastomosis.

The graft was turned along its axis by 90 ° counterclockwise so that the mesenteric part of the graft was located in the direction of the mechanical suture towards the duodenum.

Two rows of sutures were imposed between the graft and the stomach stump in the area between the second and third mechanical sutures up to 3 cm long, forming an anastomosis. In this case, a valve was formed by intussusception of the mobilized portion of the graft into the lumen of the gastric stump in the form of a duplicate by imposing interrupted sutures on the anterior lip of the anastomosis with the capture of the edge of the serous-muscular membrane of the graft, formed as a result of a circular incision, and the serous-muscular membrane of the gastric stump. Serous-muscular sutures were applied, covering the mechanical sutures of the resection lines.

The created fornix of the stomach was sutured to the colonic graft, thus covering the suture of the anastomosis and forming an acute angle of His. The early postoperative period was uneventful, the decompression gastric tube was removed on day 6, oral feeding was started on day 10.

At a control study six months after the operation, the patient subjectively presents no complaints. With an objective examination:

FGS from 19.08.02: In the area of ​​the esophagus mouth there is an anastomosis, closed, we pass freely with a 10 mm tube of the apparatus, pink mucosa without inflammatory and cicatricial changes. The mucous membrane of the colonic "esophagus" is of normal color, the valvular colic-gastric anastomosis is 48 cm from the incisors, we pass freely, there are no defects along the line of the anastomosis, the mucosa is without inflammatory changes. Also, the apparatus is held in the stump of the stomach. Gastric mucosa with signs of atrophy, no mucosal defects. The pylorus will be closed, we pass freely, the DPK is b / o.

Conclusion: Condition after plastic surgery of the esophagus. TKZH-anastomosis with normal function. Atrophic gastritis.

Fluoroscopy of the stomach No. 1491 from 08.20.02: The colonic transplant of the esophagus is located in the chest. Esophageal-colonic anastomosis end-to-end at the level of the mouth. Skips contrast well. The graft is more reminiscent of the small intestine in terms of the relief of the mucous membrane and the contours of the walls, the peristalsis is mainly translational, but there are also rare antiperistaltic waves with a reverse cast of contrast.

Conclusion: Condition after retrosternal plastic surgery of the esophagus with a colonic transplant.

When examined after 3 years:

X-ray of the stomach No. 96 dated 02.22.06: Esophageal-colonic anastomosis end-to-end at the level of the mouth, wide, freely passes barium. The colonic graft is located retrosternally, in the form of a tube, with an uneven contour due to folds that more resemble thickened folds of the small intestine than haustration of the colon. There is a transmission pulsation of the heart on n / 3 grafts with a short-term contrast delay under this area. Translational peristalsis without antiperistaltic waves. Valve colo-gastric anastomosis opens up to 19-20 mm, the supply of contrast to the stomach is portioned.

Conclusion: Condition after retrosternal plastic surgery of the esophagus with a colonic transplant.

The proposed method operated on 6 patients with the specified pathology. The observation period is up to 3.5 years. There were no complications in the immediate distant periods; a good function of the areflux mechanism was noted.

Thus, the proposed method for the formation of a colonic-gastric anastomosis in esophageal plasty makes it possible to reduce the risk of reflux in a colonic graft and its complications by creating an invagination valve from the mobilized aboral end of the graft from the antimesenteric edge and applying a circular incision of the serous-muscular membrane to the aboral end of the graft. in an oblique direction, which improves the function of the valve. Strengthening the areflux properties is achieved through the formation of the fornix of the stomach, as well as the formation of the angle of His by the imposition of serous-muscular sutures between the stump of the stomach (formed by the fornix) and the graft. The method of forming an anastomosis, consisting in the imposition of two rows of sutures, strengthening the line of sutures of the anastomosis in the area of ​​the antimesenteric part by suturing during the formation of the angle of His, significantly reduce the risk of anastomotic leakage. Modeling the stomach allows the entire organ to be included in the digestion process, which has a beneficial effect on the patient's condition in the long-term postoperative period.

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