Feasibility of single valvuloplastic esophagogastrostomy technique for laparoscopic proximal gastrectomy
Objective To investigate the feasibility of oblique overlap anastomosis plus single flap valvuloplasty(OSF)for reconstruction after laparoscopic proximal gastrectomy.Methods The C-shaped seromuscular flap(2.5 × 3.5 cm),which was 2 cm from the top of the remnant stomach,was extracorporeally created on the anterior wall of the remnant stomach.The stomach was opened approximately 1.0 cm above the lower edge of the mucosal flap.Four supporting stitches were sutured around the hole and the right wall of the esophageal stump was incised with a support suture to prevent the linear stapler from entering the submucosa.Liner stapler was inclined to the left side of the esophagus at an angle of about 30 degrees to the longitudinal axis of the esophagus for oblique anastomosis between the dorsal side of the esophagus and the anterior stomach and then esophagogastrostomy was performed with the length of anastomosis was 4 cm.Entry hole was suture with 3 stitches and then the linear stapler was used for closing the entry hole.Finally,the seromuscular flap was closed using barbed sutures.Results Clinical data of 11 patients with Siewert type Ⅱ esophagogastric junction adenocarcinoma who underwent radical gastrectomy and reconstruction by OSF between January 2022 and May 2023 were retrospectively collected.There were 7 males and 4 females.The average age was(69.9±7.8)years,the BMI was(21.7±7.2)kg/m2 and the tumor size was(2.1±0.6)cm.OSF reconstruction was successfully completed in all 11 patients.The median operative time was 275(270-428)minutes,the time for OSF reconstruction was 112(80-140)minutes,and the blood loss was 50(20-400)ml.The pathological stage was 0-Ⅰ in 7 cases and Ⅱ-Ⅲ in 4 cases.The patients were fed on the 4th day(4-7 days)and discharged from hospital on the 7th day(6-9 days)after surgery.No patient had gastroesophageal reflux symptoms of grade B and above,and no patient took anti-reflux medicine.Conclusions OSF is a safe and feasible treatment for Siewert type Ⅱ esophagogastric junction adenocarcinoma.
万方数据
维普
