A newly modified esophagogastrostomy with a reliable angle of His by placing a gastric tube in the lower mediastinum in laparoscopy-assisted proximal gastrectomy

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2015-10, Vol.18 (4), p.850-858
• Main Authors: Yasuda, Atsushi, Yasuda, Takushi, Imamoto, Haruhiko, Kato, Hiroaki, Nishiki, Kohei, Iwama, Mitsuru, Makino, Tomoki, Shiraishi, Osamu, Shinkai, Masayuki, Imano, Motohiro, Furukawa, Hiroshi, Okuno, Kiyokata, Shiozaki, Hitoshi
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adenocarcinoma - surgery; Aged; Cancer Research; Esophagoscopy - adverse effects; Esophagoscopy - instrumentation; Esophagoscopy - methods; Female; Gastrectomy - methods; Gastric cancer; Gastroenterology; Gastroesophageal Reflux - etiology; Humans; Laparoscopy - instrumentation; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Postoperative Complications - epidemiology; Reconstructive Surgical Procedures - adverse effects; Reconstructive Surgical Procedures - instrumentation; Reconstructive Surgical Procedures - methods; Stomach Neoplasms - surgery; Surgical Oncology
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-014-0431-6

Background An optimal reconstruction method for proximal gastrectomy (PG) remains elusive. Esophagogastrostomy (EG) is technically simple but suffers from the disadvantage of gastroesophageal reflux. Jejunal interposition (JI) has a low rate of gastroesophageal reflux, but the procedure is more complicated, and delayed gastric emptying is a problem. Methods We created a modified EG and have used the modified technique for PG since 2006. The procedure involves shaping the remnant stomach into a gastric conduit. The EG is performed high on the anterior wall, and the conduit is kept straight by applying a circular stapler inserted from the anterior wall of the antrum. The tip of the gastric conduit is then inserted into the lower mediastinum, creating a sharp angle of His. In this retrospective cohort study, the clinical and physiological outcomes were compared between 25 patients who underwent this procedure and 21 patients who underwent JI from 2001 to 2005. Results Laparoscopic procedures were performed more frequently, and residual food and bile reflux were less common in the EG group than in the JI group. No significant differences in remnant gastritis or reflux esophagitis were observed between the two groups. However, the late complication of intestinal obstruction occurred only in the JI group. Conclusions The modified EG technique has advantages over the JI technique because of its simplicity and low incidence of residual food and bile reflux. The next step would be to explore this technique further by a prospective multi-institutional study to confirm the reproducibility of its benefits. Miniabstract: The modified EG technique has advantages over the JI technique because of its simplicity, high rate of laparoscopy use, and low incidence of gastroesophageal reflux.