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Simple and reliable transhiatal reconstruction after laparoscopic proximal gastrectomy with lower esophagectomy for Siewert type II tumors: y-shaped overlap esophagogastric tube reconstruction

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A Correction to this article was published on 19 May 2022

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Abstract

Purpose

Despite the increasing incidence of adenocarcinoma of the esophagogastric junction, laparoscopic proximal gastrectomy with lower esophagectomy (PGLE) is not widely accepted owing to the lack of standardized reconstruction techniques. In this study, we developed a new reconstruction method named y-shaped overlap esophagogastric tube reconstruction, which reproduces an angle of His and a pseudo-fornix, to be used in laparoscopic transhiatal PGLE. This study aimed to determine the feasibility of this novel reconstruction method.

Methods

This retrospective study included the analysis of short- and mid-term surgical outcomes of 30 consecutive patients with Siewert type II esophagogastric junction adenocarcinoma who underwent laparoscopic PGLE with y-shaped overlap esophagogastric tube reconstruction from April 2015 to August 2020. A novel method was used to form a 6-cm pseudo-fornix and an angle of His using the distal esophagus and a long gastric tube.

Results

The median operation time was 369 min, and the median blood loss was 28 mL. The median follow-up period after surgery was 37 months. Although two patients experienced postoperative anastomotic leakage, none of the patients developed stenosis. One patient experienced moderate reflux symptoms, whereas four patients developed moderate reflux esophagitis based on the 1-year follow-up endoscopic examination; the condition of all patients could be efficiently controlled with medication.

Conclusion

The short- and mid-term surgical outcomes of y-shaped overlap esophagogastric tube reconstruction reflected the feasibility of this simple technique and suggested its potential utility as a reconstruction alternative for Siewert type II tumors.

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Authors and Affiliations

  1. Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe-city, Hyogo, 650-0017, Japan

    Shingo Kanaji, Kohei Tanigawa, Hitoshi Harada, Naoki Urakawa, Ryuichiro Sawada, Hironobu Goto, Hiroshi Hasegawa, Kimihiro Yamashita, Takeru Matsuda, Taro Oshikiri & Yoshihiro Kakeji

  2. Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, 673-8558, Japan

    Satoshi Suzuki

  3. Department of Gastroenterological Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39, Shibata, Kita-ku, Osaka City, Japan

    Masashi Yamamoto

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  1. Shingo Kanaji
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Contributions

SK was involved in the study conception and design, participated in the sequence alignment, and drafted the manuscript. RS, MY, and KT were involved in the acquisition of data. HG, HH, KY, and TO contributed to the analysis and interpretation of data. NO, HH, TM, and SS participated in critical revision of the manuscript. YK conceived the study, participated in its design and coordination, and helped to draft the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Shingo Kanaji.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies involving animals. This study was approved by the Ethics Committee of the Kobe University.

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All patients provided written informed consent for use of anonymous data related to their surgery.

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The authors affirm that the human research participants provided informed consent for publication of the images in Fig. 1a, b, and c.

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The authors declare no competing interests.

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Kanaji, S., Suzuki, S., Yamamoto, M. et al. Simple and reliable transhiatal reconstruction after laparoscopic proximal gastrectomy with lower esophagectomy for Siewert type II tumors: y-shaped overlap esophagogastric tube reconstruction. Langenbecks Arch Surg 407, 1881–1890 (2022). https://doi.org/10.1007/s00423-022-02536-2

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