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Safety and short-term outcomes of a modified valvuloplastic esophagogastrostomy versus gastric tube anastomosis after laparoscopy-assisted proximal gastrectomy: a retrospective cohort study.
- Source :
- Surgical Endoscopy & Other Interventional Techniques; Mar2024, Vol. 38 Issue 3, p1523-1532, 10p
- Publication Year :
- 2024
-
Abstract
- 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. [ABSTRACT FROM AUTHOR]
- Subjects :
- STOMACH tumors
LENGTH of stay in hospitals
SURGICAL anastomosis
ENDOSCOPIC surgery
TIME
CONVALESCENCE
SURGICAL complications
RETROSPECTIVE studies
ACQUISITION of data
TREATMENT duration
MANN Whitney U Test
FISHER exact test
GASTRECTOMY
TREATMENT effectiveness
COMPARATIVE studies
GASTROESOPHAGEAL reflux
PROTON pump inhibitors
LAPAROSCOPY
MEDICAL records
DESCRIPTIVE statistics
CHI-squared test
RESEARCH funding
ESOPHAGUS diseases
ESOPHAGEAL stenosis
CATHETERIZATION
DATA analysis software
ESOPHAGEAL tumors
PATIENT safety
LONGITUDINAL method
ENDOSCOPY
Subjects
Details
- Language :
- English
- ISSN :
- 18666817
- Volume :
- 38
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- Surgical Endoscopy & Other Interventional Techniques
- Publication Type :
- Academic Journal
- Accession number :
- 175566571
- Full Text :
- https://doi.org/10.1007/s00464-023-10663-0