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Linear stapler anastomosis for esophagogastrostomy in laparoscopic proximal gastrectomy reduce reflux esophagitis

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Abstract

Purpose

There are various reconstruction methods for Laparoscopic proximal gastrectomy (LPG), such as esophagogastrostomy (EG), double-tract reconstruction, and jejunal interposition. We have performed EG using a circular stapler (OrVil) from 2013 and using a linear stapler from 2017. The aim of this retrospective study was to clarify which stapler is better for EG for LPG.

Methods

The data of 84 patients who underwent EG for LPG between January 2013 and September 2019 were analyzed. EG with fundoplication was done using a circular stapler (OrVil) in 45 patients (CS group) and a linear stapler in 39 patients (LS group). The patients’ medical records were reviewed. Clinical symptoms were obtained by interview at each outpatient consultation. All patients underwent postoperative 1-year follow-up endoscopy. To minimize bias between the two groups, propensity scores were calculated using a logistic regression model. After propensity-score matching, 60 patients (30 in the CS group and 30 in the LS group) were studied.

Results

Patient characteristics, operative outcomes were similar in two groups. Anastomotic leakage occurred in one patient (3.3%) in both groups. Anastomotic stenosis occurred in five patients (16.7%) in the CS group and two patients (6.7%) in the LS group. The rate of patients with severe reflux esophagitis (grade C or D) was significantly lower in the LS group (3.4%) than in the CS group (26.7%) (p = 0.026).

Conclusions

EG with a linear stapler could reduce the risk of severe reflux esophagitis, and it could be a safe and feasible anastomosis for patients after LPG.

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Acknowledgements

The authors sincerely thank all the participants.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka-shi, Saitama, 350-1298, Japan

    Hirofumi Sugita, Shinichi Sakuramoto, Shuichiro Oya, Naoto Fujiwara, Yutaka Miyawaki, Hiroshi Satoh, Kojun Okamoto, Shigeki Yamaguchi & Isamu Koyama

Authors
  1. Hirofumi Sugita
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  2. Shinichi Sakuramoto
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  3. Shuichiro Oya
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  4. Naoto Fujiwara
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  5. Yutaka Miyawaki
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  6. Hiroshi Satoh
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  7. Kojun Okamoto
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  8. Shigeki Yamaguchi
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  9. Isamu Koyama
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Correspondence to Hirofumi Sugita.

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This study was conducted in accordance with the 1995 Declaration of Helsinki and approved by the Saitama Medical University International Medical Center Research Ethics Committee (18–268). Informed consent was waived because of the retrospective study design.

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Sugita, H., Sakuramoto, S., Oya, S. et al. Linear stapler anastomosis for esophagogastrostomy in laparoscopic proximal gastrectomy reduce reflux esophagitis. Langenbecks Arch Surg 406, 2709–2716 (2021). https://doi.org/10.1007/s00423-021-02250-5

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  • DOI: https://doi.org/10.1007/s00423-021-02250-5

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