A modified esophagogastric reconstruction method after laparoscopic proximal gastrectomy: A technical note with video vignette

The transhiatal tunnel valvuloplasty technique following laparoscopic proximal gastrectomy: the single-center experience in a retrospective cohort

BACKGROUND

The debate over the optimal reconstruction technique following proximal gastrectomy continues. Transhiatal tunnel valvuloplasty (ThTV) is a novel esophagogastrostomy method. This study aimed to evaluate the feasibility and safety of ThTV.

METHODS

A cohort with upper early gastric cancer or Siewert type II tumors who underwent laparoscopic proximal gastrectomy was retrospectively reviewed in a single center. The ThTV esophagogastrostomy procedure involved placing a lengthy gastric tube into the lower mediastinum and firmly binding it to the esophagus. Demographic and surgical morbidity data were extracted from the medical records.

RESULTS

Between March 2023 and November 2023, 15 patients underwent laparoscopic proximal gastrectomy using ThTV. The cohort consisted of 13 males and 2 females, with a median age of 68 years (range 49-77). The median operative time was 213 minutes (range 171-370). The median times for tunnel construction and anastomosis were 7 minutes (range 4-30) and 17 minutes (range 10-29), respectively. The median tumor size was 2.0 cm (range 1.0-5.0), and the median number of lymph nodes dissected was 29 (range 13-49). TNM staging revealed 9 cases of stage I, 5 cases of stage II, and 1 case of stage III. As of January 1, 2025, the median follow-up duration was 16.8 months (range 13.8-22.2). No tumor recurrence was observed. No patients reported severe reflux symptoms (Visick score ≥III). Gastroscopy confirmed reflux esophagitis (Los Angeles classification Grade A) in one patient, and an anastomotic stricture requiring endoscopic balloon dilation was observed in another patient.

CONCLUSIONS

Transhiatal tunnel valvuloplasty is a simple and reliable anti-reflux method following laparoscopic proximal gastric surgery. The further verification of the esophageal function is warranted.

Safety and short-term outcomes of a modified valvuloplastic esophagogastrostomy versus gastric tube anastomosis after laparoscopy-assisted proximal gastrectomy: a retrospective cohort study

BACKGROUND

There is no optimal reconstruction method after proximal gastrectomy. The valvuloplastic esophagogastrostomy can reduce postoperative reflux esophagitis, but it is technically complex with a long operation time. The gastric tube anastomosis is technically simple, but the incidences of reflux esophagitis and anastomotic stricture are higher.

METHODS

We have devised a modified valvuloplastic esophagogastrostomy after laparoscopy-assisted proximal gastrectomy (LAPG), the arch-bridge anastomosis. After reviewing our prospectively maintained gastric cancer database, 43 patients who underwent LAPG from November 2021 to April 2023 were included in this cohort study, with 25 patients received the arch-bridge anastomosis and 18 patients received gastric tube anastomosis. The short-term outcomes were compared between the two groups to evaluate the efficacy of the arch-bridge anastomosis. Reporting was consistent with the STROCSS 2021 guideline.

RESULTS

The median operation time was 180 min in the arch-bridge group, significantly shorter than the gastric tube group (p = 0.003). In the arch-bridge group, none of the 25 patients experienced anastomotic leakage, while one patient (4%) experienced anastomotic stricture requiring endoscopic balloon dilation. The postoperative length of stay was shorter in the arch-bridge group (9 vs. 11, p = 0.034). None of the patients in the arch-bridge group experienced gastroesophageal reflux and used proton pump inhibitor (PPI), while four (22.2%) patients in the gastric tube group used PPI (p = 0.025). The incidence of reflux esophagitis (Los Angeles grade B or more severe) by endoscopy was lower in the arch-bridge group (0% vs. 25.0%).

CONCLUSION

The arch-bridge anastomosis is a safe, time-saving, and feasible reconstruction method. It can reduce postoperative reflux and anastomotic stricture incidences in a selected cohort of patients undergoing laparoscopy-assisted proximal gastrectomy.