Skip to main content

Advertisement

SpringerLink
Log in

Non-flap hand-sewn esophagogastrostomy as a simple anti-reflux procedure in laparoscopic proximal gastrectomy for gastric cancer

  • How-I-Do-It articles
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Aims

No ideal and generally accepted method of reconstruction for laparoscopic proximal gastrectomy (LPG) has been established because of a high incidence of postoperative reflux and anastomotic stenosis. The aim of this study was to evaluate the short-term outcomes of LPG with a non-flap hand-sewn technique as a simple anti-reflux procedure for the upper part of clinical Stage I gastric cancer.

Methods

Between November 2016 and June 2019, 23 consecutive gastric cancer patients, who underwent curative LPG with lymphadenectomy, were enrolled in the study. In this study, we devised a simple hand-sewn technique for esophagogastrostomy, which comprises a 5-cm pseudo-fornix as a fundoplication, the posterior pressure mechanism by the remnant stomach and bilateral crus, and a flat-shaped anastomotic hole as a valvuloplasty.

Results

The median operation time and hospital stay was 325 min and 10 days, respectively. There was no patient with anastomotic leakage and delayed gastric empting. No patient had symptoms of gastroesophageal reflux, but two patients (8.6% (2/23): Grade M and Grade A) had endoscopic findings during a follow-up period of more than 6 months. There was no patient with Grade B or more severe reflux esophagitis. One patient (4.3%, 1/23) developed anastomotic stenosis, which was resolved with endoscopic dilatation. The mean body weight loss at 6 months after surgery was 7.5% in comparison with the preoperative body weight.

Conclusion

Our non-flap hand-sewn technique for esophagogastrostomy had favorable outcomes and might be one of reliable techniques as an anti-reflux procedure in LPG for gastric cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kitano S, Iso Y, Moriyama M, Sugimachi K (1994) Laparoscopy-assisted Billroth I gastrectomy. Surg Laparosc Endosc 4(2):146–148

    CAS  PubMed  Google Scholar 

  2. Kitano S, Shiraishi N, Uyama I, Sugihara K, Tanigawa N (2007) A multicenter study on oncologic outcome of laparoscopic gastrectomy for early cancer in Japan. Ann Surg 245(1):68–72. https://doi.org/10.1097/01.sla.0000225364.03133.f8

    Article  PubMed  PubMed Central  Google Scholar 

  3. Kim HH, Han SU, Kim MC, Hyung WJ, Kim W, Lee HJ, Ryu SW, Cho GS, Song KY, Ryu SY (2014) Long-term results of laparoscopic gastrectomy for gastric cancer: a large-scale case-control and case-matched Korean multicenter study. Journal of clinical oncology : official journal of the American Society of Clinical Oncology 32(7):627–633. https://doi.org/10.1200/jco.2013.48.8551

    Article  Google Scholar 

  4. Honda M, Hiki N, Kinoshita T, Yabusaki H, Abe T, Nunobe S, Terada M, Matsuki A, Sunagawa H, Aizawa M, Healy MA, Iwasaki M, Furukawa TA (2016) Long-term outcomes of laparoscopic versus open surgery for clinical stage I gastric cancer: the LOC-1 study. Ann Surg 264(2):214–222. https://doi.org/10.1097/sla.0000000000001654

    Article  PubMed  PubMed Central  Google Scholar 

  5. Veenhof AA, Vlug MS, van der Pas MH, Sietses C, van der Peet DL, de Lange-de Klerk ES, Bonjer HJ, Bemelman WA, Cuesta MA (2012) Surgical stress response and postoperative immune function after laparoscopy or open surgery with fast track or standard perioperative care: a randomized trial. Ann Surg 255(2):216–221. https://doi.org/10.1097/SLA.0b013e31824336e2

    Article  CAS  PubMed  Google Scholar 

  6. Ahn HS, Lee HJ, Yoo MW, Jeong SH, Park DJ, Kim HH, Kim WH, Lee KU, Yang HK (2011) Changes in clinicopathological features and survival after gastrectomy for gastric cancer over a 20-year period. Br J Surg 98(2):255–260. https://doi.org/10.1002/bjs.7310

    Article  CAS  PubMed  Google Scholar 

  7. Devesa SS, Blot WJ, Fraumeni JF Jr (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83(10):2049–2053

    Article  CAS  Google Scholar 

  8. Komatsu S, Otsuji E (2019) Essential updates 2017/2018: recent topics in the treatment and research of gastric cancer in Japan. Annals of gastroenterological surgery 3(6):581–591. https://doi.org/10.1002/ags3.12284

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ichikawa D, Komatsu S, Kubota T, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E (2014) Long-term outcomes of patients who underwent limited proximal gastrectomy. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 17(1):141–145. https://doi.org/10.1007/s10120-013-0257-7

    Article  Google Scholar 

  10. Kosuga T, Ichikawa D, Komatsu S, Okamoto K, Konishi H, Shiozaki A, Fujiwara H, Otsuji E (2015) Feasibility and nutritional benefits of laparoscopic proximal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol 22(Suppl 3):S929–S935. https://doi.org/10.1245/s10434-015-4590-4

    Article  PubMed  Google Scholar 

  11. Hayami M, Hiki N, Nunobe S, Mine S, Ohashi M, Kumagai K, Ida S, Watanabe M, Sano T, Yamaguchi T (2017) Clinical outcomes and evaluation of laparoscopic proximal gastrectomy with double-flap technique for early gastric Ccancer in the upper third of the stomach. Ann Surg Oncol 24(6):1635–1642. https://doi.org/10.1245/s10434-017-5782-x

    Article  PubMed  Google Scholar 

  12. Kojima M, Hosoda H, Date Y, Nakazato M, Matsuo H, Kangawa K (1999) Ghrelin is a growth-hormone-releasing acylated peptide from stomach. Nature 402(6762):656–660. https://doi.org/10.1038/45230

    Article  CAS  PubMed  Google Scholar 

  13. Adachi S, Takiguchi S, Okada K, Yamamoto K, Yamasaki M, Miyata H, Nakajima K, Fujiwara Y, Hosoda H, Kangawa K, Mori M, Doki Y (2010) Effects of ghrelin administration after total gastrectomy: a prospective, randomized, placebo-controlled phase II study. Gastroenterology 138(4):1312–1320. https://doi.org/10.1053/j.gastro.2009.12.058

    Article  CAS  PubMed  Google Scholar 

  14. Takeuchi H, Oyama T, Kamiya S, Nakamura R, Takahashi T, Wada N, Saikawa Y, Kitagawa Y (2011) Laparoscopy-assisted proximal gastrectomy with sentinel node mapping for early gastric cancer. World J Surg 35(11):2463–2471. https://doi.org/10.1007/s00268-011-1223-3

    Article  PubMed  Google Scholar 

  15. Lim CH, Kim SW, Kim WC, Kim JS, Cho YK, Park JM, Lee IS, Choi MG, Song KY, Jeon HM, Park CH (2012) Anemia after gastrectomy for early gastric cancer: long-term follow-up observational study. World J Gastroenterol 18(42):6114–6119. https://doi.org/10.3748/wjg.v18.i42.6114

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. An JY, Youn HG, Choi MG, Noh JH, Sohn TS, Kim S (2008) The difficult choice between total and proximal gastrectomy in proximal early gastric cancer. Am J Surg 196(4):587–591. https://doi.org/10.1016/j.amjsurg.2007.09.040

    Article  PubMed  Google Scholar 

  17. Nakamura M, Yamaue H (2016) Reconstruction after proximal gastrectomy for gastric cancer in the upper third of the stomach: a review of the literature published from 2000 to 2014. Surg Today 46(5):517–527. https://doi.org/10.1007/s00595-015-1185-4

    Article  PubMed  Google Scholar 

  18. Kinoshita T, Gotohda N, Kato Y, Takahashi S, Konishi M, Kinoshita T (2013) Laparoscopic proximal gastrectomy with jejunal interposition for gastric cancer in the proximal third of the stomach: a retrospective comparison with open surgery. Surg Endosc 27(1):146–153. https://doi.org/10.1007/s00464-012-2401-6

    Article  PubMed  Google Scholar 

  19. Ahn SH, Jung DH, Son SY, Lee CM, Park DJ, Kim HH (2014) Laparoscopic double-tract proximal gastrectomy for proximal early gastric cancer. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 17(3):562–570. https://doi.org/10.1007/s10120-013-0303-5

    Article  Google Scholar 

  20. Nakamura M, Nakamori M, Ojima T, Katsuda M, Iida T, Hayata K, Matsumura S, Kato T, Kitadani J, Iwahashi M, Yamaue H (2014) Reconstruction after proximal gastrectomy for early gastric cancer in the upper third of the stomach: an analysis of our 13-year experience. Surgery 156(1):57–63. https://doi.org/10.1016/j.surg.2014.02.015

    Article  PubMed  Google Scholar 

  21. Wang S, Lin S, Wang H, Yang J, Yu P, Zhao Q, Li M (2018) Reconstruction methods after radical proximal gastrectomy: a systematic review. Medicine 97(11):e0121. https://doi.org/10.1097/md.0000000000010121

    Article  PubMed  PubMed Central  Google Scholar 

  22. Uyama I, Ogiwara H, Takahara T, Kikuchi K, Iida S (1995) Laparoscopic and minilaparotomy proximal gastrectomy and esophagogastrostomy: technique and case report. Surgical laparoscopy & endoscopy 5(6):487–491

    CAS  Google Scholar 

  23. Tsujimoto H, Uyama I, Yaguchi Y, Kumano I, Takahata R, Matsumoto Y, Yoshida K, Horiguchi H, Aosasa S, Ono S, Yamamoto J, Hase K (2012) Outcome of overlap anastomosis using a linear stapler after laparoscopic total and proximal gastrectomy. Langenbeck's Arch Surg 397(5):833–840. https://doi.org/10.1007/s00423-012-0939-3

    Article  Google Scholar 

  24. Yamashita Y, Yamamoto A, Tamamori Y, Yoshii M, Nishiguchi Y (2017) Side overlap esophagogastrostomy to prevent reflux after proximal gastrectomy. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 20(4):728–735. https://doi.org/10.1007/s10120-016-0674-5

    Article  Google Scholar 

  25. Hiki N, Fukunaga T, Yamaguchi T, Nunobe S, Tokunaga M, Ohyama S, Seto Y, Muto T (2007) Laparoscopic esophagogastric circular stapled anastomosis: a modified technique to protect the esophagus. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 10(3):181–186. https://doi.org/10.1007/s10120-007-0433-8

    Article  Google Scholar 

  26. Ichikawa D, Komatsu S, Okamoto K, Shiozaki A, Fujiwara H, Otsuji E (2012) Esophagogastrostomy using a circular stapler in laparoscopy-assisted proximal gastrectomy with an incision in the left abdomen. Langenbeck's Arch Surg 397(1):57–62. https://doi.org/10.1007/s00423-011-0840-5

    Article  Google Scholar 

  27. Okabe H, Obama K, Tanaka E, Tsunoda S, Akagami M, Sakai Y (2013) Laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis using a knifeless endoscopic linear stapler. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 16(2):268–274. https://doi.org/10.1007/s10120-012-0181-2

    Article  Google Scholar 

  28. Hosogi H, Yoshimura F, Yamaura T, Satoh S, Uyama I, Kanaya S (2014) Esophagogastric tube reconstruction with stapled pseudo-fornix in laparoscopic proximal gastrectomy: a novel technique proposed for Siewert type II tumors. Langenbeck's Arch Surg 399(4):517–523. https://doi.org/10.1007/s00423-014-1163-0

    Article  Google Scholar 

  29. Ojima T, Nakamori M, Nakamura M, Hayata K, Maruoka S, Yamaue H (2018) Fundoplication with 180-degree wrap during esophagogastrostomy after robotic proximal gastrectomy for early gastric cancer. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 22(8):1475–1476. https://doi.org/10.1007/s11605-018-3765-2

    Article  Google Scholar 

  30. Kuroda S, Nishizaki M, Kikuchi S, Noma K, Tanabe S, Kagawa S, Shirakawa Y, Fujiwara T (2016) Double-flap technique as an antireflux procedure in esophagogastrostomy after proximal gastrectomy. J Am Coll Surg 223(2):e7–e13. https://doi.org/10.1016/j.jamcollsurg.2016.04.041

    Article  PubMed  Google Scholar 

  31. Muraoka A, Kobayashi M, Kokudo Y (2016) Laparoscopy-assisted proximal gastrectomy with the hinged double flap method. World J Surg 40(10):2419–2424. https://doi.org/10.1007/s00268-016-3510-5

    Article  PubMed  Google Scholar 

  32. Hosoda K, Yamashita K, Moriya H, Mieno H, Ema A, Washio M, Watanabe M (2017) Laparoscopically assisted proximal gastrectomy with esophagogastrostomy using a novel "open-door" technique : LAPG with novel reconstruction. Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract 21(7):1174–1180. https://doi.org/10.1007/s11605-016-3341-6

    Article  Google Scholar 

  33. Kamikawa YKT, Ueyama S (2001) A new antireflux procedure in esophagogastrostomy after proximal gastrectomy. Shokakigeka 24(7):1053–1060

    Google Scholar 

  34. Tanigawa N, Lee SW, Kimura T, Mori T, Uyama I, Nomura E, Okuda J, Konishi F (2011) The endoscopic surgical skill qualification system for gastric surgery in Japan. Asian J Endosc Surg 4(3):112–115. https://doi.org/10.1111/j.1758-5910.2011.00082.x

    Article  CAS  PubMed  Google Scholar 

  35. Japanese classification of gastric carcinoma (2011) 3rd English edition. Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 14(2):101–112. https://doi.org/10.1007/s10120-011-0041-5

    Article  Google Scholar 

  36. Japanese gastric cancer treatment guidelines (2014) (ver. 4) (2017). Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 20(1):1–19. https://doi.org/10.1007/s10120-016-0622-4

    Article  Google Scholar 

  37. Lee SW, Kawai M, Tashiro K, Nomura E, Tokuhara T, Kawashima S, Tanaka R, Uchiyama K (2016) Laparoscopic gastrointestinal anastomoses using knotless barbed absorbable sutures are safe and reproducible: a single-center experience with 242 patients. Jpn J Clin Oncol 46(4):329–335. https://doi.org/10.1093/jjco/hyv212

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  Google Scholar 

  39. Okada N, Kuriyama T, Umemoto H, Komatsu T, Tagami Y (1974) Esophageal surgery: a procedure for posterior invagination esophagogastrostomy in one-stage without positional change. Ann Surg 179(1):27–34. https://doi.org/10.1097/00000658-197401000-00006

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Polkowski WP, Mielko J, Gęca K, Rawicz-Pruszyński K, Ciseł B, Kurylcio A, Skórzewska M (2020) Proximal Gastric Resection with Posterior Esophago-Gastrostomy and Partial Neo-Fundoplication in the Treatment of Advanced Upper Gastric Carcinoma. Dig Surg 37(2):119–128. https://doi.org/10.1159/000497452

    Article  PubMed  Google Scholar 

  41. Kataoka K, Katai H, Mizusawa J, Katayama H, Nakamura K, Morita S, Yoshikawa T, Ito S, Kinoshita T, Fukagawa T, Sasako M (2016) Non-randomized confirmatory trial of laparoscopy-assisted total gastrectomy and proximal gastrectomy with nodal dissection for clinical stage I gastric cancer: Japan Clinical Oncology Group Study JCOG1401. Journal of gastric cancer 16(2):93–97. https://doi.org/10.5230/jgc.2016.16.2.93

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

The authors would like to thank Dr. Shinya Yamanaka and Dr. Naoya Tomatsuri (Department of Gastroenterology, Kyoto First Red Cross Hospital, Kyoto, Japan) for their technical assistance of 24-h impedance- pH monitoring. Also, we are grateful to the referees for useful comments in this study.

Author information

Authors and Affiliations

  1. Division of Digestive Surgery (Gastric Surgery Division), Department of Surgery, Kyoto Prefectural University of Medicine, 465 Kawaramachi-hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan

    Shuhei Komatsu, Toshiyuki Kosuga, Takeshi Kubota, Kazuma Okamoto & Eigo Otsuji

  2. Department of Surgery (Gastric Surgery Division), Kyoto First Red Cross Hospital, 15-749 Honmachi, Higashiyama-ku, Kyoto, 605-0981, Japan

    Shuhei Komatsu, Tatsuya Kumano & Yasuhiro Shioaki

  3. First Department of Surgery, Faculty of Medicine, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi, 409-3898, Japan

    Daisuke Ichikawa

Authors
  1. Shuhei Komatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Toshiyuki Kosuga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Takeshi Kubota
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tatsuya Kumano
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kazuma Okamoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daisuke Ichikawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yasuhiro Shioaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Eigo Otsuji
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Shuhei Komatsu, Toshiyuki Kosuga, Takeshi Kubota, Tatsuya Kumano, Kazuma Okamoto, Daisuke Ichikawa, Yasuhiro Shioaki, and Eigo Otsuji performed the research and analyzed data, and Shuhei Komatsu wrote the paper.

Corresponding author

Correspondence to Shuhei Komatsu.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This study did not include any experiments on animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Komatsu, S., Kosuga, T., Kubota, T. et al. Non-flap hand-sewn esophagogastrostomy as a simple anti-reflux procedure in laparoscopic proximal gastrectomy for gastric cancer. Langenbecks Arch Surg 405, 541–549 (2020). https://doi.org/10.1007/s00423-020-01900-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-020-01900-4

Keywords

Search

Navigation