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Laparoscopically Assisted Proximal Gastrectomy with Esophagogastrostomy Using a Novel “Open-Door” Technique

LAPG with Novel Reconstruction

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Abstract

Laparoscopy-assisted proximal gastrectomy (LAPG) with esophagogastrostomy using a novel “open-door” technique was introduced recently, with the aim of preventing gastroesophageal reflux. However, quantitate assessment of gastroesophageal reflux after this surgery has not been performed till date. The aims of the current study were to investigate the safety and feasibility of this operation and to elucidate the postoperative reflux status. Twenty consecutive patients (18 men) with (y)cStage I gastric cancer in the upper third of the stomach who underwent LAPG at Kitasato University Hospital from May 2015 through September 2016 were retrospectively reviewed. We performed 24-h impedance-pH monitoring 3 months after surgery for the first eight patients and analyzed the postoperative reflux status. Median operation time was 333 min, while median anastomotic time was 81 min. None of the 20 patients experienced anastomotic leakage while two patients experienced anastomotic stricture requiring endoscopic balloon dilatation. No patient experienced heartburn without antacid drugs. During the 24-h impedance-pH monitoring, all but one patient had normal gastroesophageal acid reflux with the acid percent time of <1.1% and reflux percent time of <1.4%. One patient with marginally abnormal postoperative gastroesophageal reflux had a normal DeMeester score of 3.0. Our results showed that esophagogastrostomy using the “open-door” technique is a safe and feasible procedure for LAPG. The degree of gastroesophageal reflux was acceptable using this technique. Randomized controlled trials with long-term follow-ups are required to confirm that this technique would be superior to the others.

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Authors’ Contributions

All authors have made substantial contributions to the design and analysis of this work as well as drafting and appraisal of the manuscript. All authors have approved the final manuscript for submission and agreed to be accountable for the work.

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Correspondence to Kei Hosoda.

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Disclosures

Drs. Kei Hosoda, Keishi Yamashita, Hiromitsu Moriya, Hiroaki Mieno, and Masahiko Watanabe have no conflicts of interest or financial ties to disclose.

Conflicts of Interest and Sources of Funding

None declared

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Hosoda, K., Yamashita, K., Moriya, H. et al. Laparoscopically Assisted Proximal Gastrectomy with Esophagogastrostomy Using a Novel “Open-Door” Technique. J Gastrointest Surg 21, 1174–1180 (2017). https://doi.org/10.1007/s11605-016-3341-6

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Keywords

  • Proximal gastrectomy
  • Gastric cancer
  • Esophagogastrostomy
  • Gastroesophageal reflux
  • Laparoscopic surgery
  • 24-h impedance-pH monitoring
  • Open-door technique