Modified Kamikawa anastomosis after proximal gastrectomy: A narrative review

Figure 1 Main procedural steps of modified Kamikawa anastomosis after proximal gastrectomy. A-C: Exposure of the esophageal hiatus and the right diaphragmatic sac to expose both pleurae; D: Dissection of mesoesophagus and mobilization of the lower esophagus; E: Horizontal H-shaped marking on the anterior wall of the gastric remnant using gentian violet; F: Dissection between the submucosa and muscularis layers to create double seromuscular flaps; G: Creation of a gastric opening along the inferior edge of the ‘mucosal window’; H: Fixation of the posterior esophageal wall to the gastric remnant; I: Continuous suturing of the posterior wall of the esophageal opening and the upper lip of gastric opening; J: Continuous suturing of the anterior wall of the esophageal opening and the lower lip of gastric opening; K and L: Continuous suturing of the inferior flap edges and the adjacent gastric wall from each side to the midpoint, followed by continuous suturing upward and obliquely toward each side to fix the bilateral flaps together to the esophageal adventitia; M: Formation of a Y-shaped collar-like structure covering the anastomosis and lower esophageal segment.