Anti-reflux effects of a novel esophagogastric asymmetric anastomosis technique after laparoscopic proximal gastrectomy

Abstract

BACKGROUND

Reflux esophagitis is a common postoperative complication of proximal gastrectomy. There is an urgent need for a safer method of performing esophageal-gastric anastomosis that reduces the risk of reflux after proximal gastrectomy. We hypothesize that a novel technique termed esophagogastric asymmetric anastomosis (EGAA) can prevent postoperative reflux in a safe and feasible manner.

AIM

To observe a novel method of EGAA to prevent postoperative reflux.

METHODS

Initially, we employed a thermal stress computer to simulate and analyze gastric peristalsis at the site of an esophagogastric asymmetric anastomosis. This was done in order to better understand the anti-reflux function and mechanism. Next, we performed digestive tract reconstruction using the EGAA technique in 13 patients who had undergone laparoscopic proximal gastrectomy. Post-surgery, we monitored the structure and function of the reconstruction through imaging exams and gastroscopy. Finally, the patients were followed up to assess the efficacy of the anti-reflux effects.

RESULTS

Our simulation experiments have demonstrated that the clockwise contraction caused by gastric peristalsis and the expansion of the gastric fundus caused by the increase of intragastric pressure could significantly tighten the anastomotic stoma, providing a means to prevent the reverse flow of gastric fluids. Thirteen patients with esophagogastric junction tumors underwent laparoscopic proximal gastrectomy, with a mean operation time of 304.2 ± 44.3 min. After the operation, the upper gastroenterography in supine/low head positions showed that eight patients exhibited no gastroesophageal reflux, three had mild reflux, and two had obvious reflux. The abdominal computed tomography examination showed a valve-like structure at the anastomosis. During follow-up, gastroscopy revealed a closed valve-like form at the anastomosis site without stenosis or signs of reflux esophagitis in 11 patients. Only two patients showed gastroesophageal reflux symptoms and mild reflux esophagitis and were treated with proton pump inhibitor therapy.

CONCLUSION

EGAA is a feasible and safe surgical method, with an excellent anti-reflux effect after proximal gastrectomy.

Keywords: Esophagogastric junction tumor; Proximal gastrectomy; Digestive tract reconstruction; Esophagogastric asymmetric anastomosis; Reflux esophagitis; Gastroenterography

Core Tip: Reflux esophagitis is a common postoperative complication after proximal gastrectomy that can seriously affect the quality of life of these patients. We studied the novel surgical procedure termed esophagogastric asymmetric anastomosis (EGAA) as a potential solution to this post-surgery complication. Post-operatively, the results of upper gastroenterography showed no signs of gastroesophageal reflux while abdominal computed tomography examination findings showed a valve-like structure at the anastomosis. During follow-up, gastroscopy results revealed a closed valve-like form at the anastomosis site without stenosis or signs of reflux esophagitis. Our data suggest that EGAA is a feasible and safe procedure with excellent anti-reflux outcomes after proximal gastrectomy.