Study on the perioperative safety and anti-reflux effect of different digestive tract reconstructions after laparoscopic proximal gastrectomy

doi:10.3877/cma.j.issn.1674-3946.2025.03.012.

Abstract

Abstract:

Objective

To study the perioperative safety and anti-reflux effect of different digestive tract reconstructions after laparoscopic proximal gastrectomy.

Methods

The case data of 61 patients who underwent surgery for adenocarcinoma of the esophagogastric junction from December 2022 to December 2023 were retrospectively analyzed.According to different digestive tract reconstruction methods，they were divided into the observation group （n=31 cases） and the control group （n=30 cases）.The observation group underwent modified single muscular flap anastomosis for digestive tract reconstruction，and the control group underwent interposition jejunal anastomosis for digestive tract reconstruction.The statistical software SPSS 22.0 was used for statistical analysis of the data.All data were subjected to a normality test.Measurement data such as perioperative indexes and dynamic esophageal pH monitoring indexes were expressed as （±s），and an independent samples t test was performed.Counting data of postoperative complications were expressed as［cases （%）］，and the chi-square test or Fisher’s exact probability method was used.A P value less than 0.05 indicated a statistically significant difference.

Results

All 61 patients successfully completed total proximal gastrectomy without conversion to laparotomy.The time for digestive tract reconstruction in the observation group was less than that in the control group （P＜0.05）.The statistical results of postoperative follow-up showed that the number of refluxes with pH ＜ 4，the percentage of time with pH ＜ 4，the longest reflux time，the number of times with reflux duration ＞ 5 minutes，and the Biox-Ochoa score in the observation group were all lower than those in the control group，and the differences were statistically significant （P＜0.05）.There was no statistically significant difference in the incidence of complications between the observation group and the control group （3.2%vs. 20.0%，P＞0.05）.

Conclusion

Both modified single muscular flap anastomosis and interposition jejunal anastomosis in proximal gastrectomy are generally safe and feasible.However，the modified single muscular flap anastomosis is simple to operate and has a definite anti-reflux effect，which is worthy of further clinical promotion and application.

Key words: Adenocarcinoma of Esophagogastic Junction, Proximal Gastrectomy, Modified Single Muscle Flap Anastomosis, Reflux Esophagistis, Laparoscopes

Hailong Ma, Shaofeng Wu, Mao Wang, Xuefeng Chen, Yinhai Dai. Study on the perioperative safety and anti-reflux effect of different digestive tract reconstructions after laparoscopic proximal gastrectomy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 274-277.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.03.012.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I03/274

Figures/Tables 4

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI，（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI，（kg/m²， $\overset{ˉ}{x}$ ±s）
观察组	31	16/15	58. 1±6. 9	22. 6±3. 2
对照组	30	18/12	56. 4±7. 3	21. 8±4. 9
χ ²/t值		0. 435	0. 935	0. 757
P值		0. 510	0. 354	0. 452
组别	例数	肿瘤分期（例）	肿瘤直径（cm， $\overset{ˉ}{x}$ ±s）	浸润深度（例）
组别	例数	Ⅰ/Ⅱ	肿瘤直径（cm， $\overset{ˉ}{x}$ ±s）	T₁/T₂
观察组	31	14/17	2. 5±1. 7	17/14
对照组	30	14/16	2. 8±1. 5	15/15
χ ²/t值		0. 014	-0. 730	0. 143
P值		0. 906	0. 468	0. 705

组别	例数	性别（例）	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI，（kg/m²， $\overset{ˉ}{x}$ ±s）
组别	例数	男/女	年龄（岁， $\overset{ˉ}{x}$ ±s）	BMI，（kg/m²， $\overset{ˉ}{x}$ ±s）
观察组	31	16/15	58. 1±6. 9	22. 6±3. 2
对照组	30	18/12	56. 4±7. 3	21. 8±4. 9
χ ²/t值		0. 435	0. 935	0. 757
P值		0. 510	0. 354	0. 452
组别	例数	肿瘤分期（例）	肿瘤直径（cm， $\overset{ˉ}{x}$ ±s）	浸润深度（例）
组别	例数	Ⅰ/Ⅱ	肿瘤直径（cm， $\overset{ˉ}{x}$ ±s）	T₁/T₂
观察组	31	14/17	2. 5±1. 7	17/14
对照组	30	14/16	2. 8±1. 5	15/15
χ ²/t值		0. 014	-0. 730	0. 143
P值		0. 906	0. 468	0. 705

组别	例数	手术时间（min）	术中出血量（ml）	淋巴清扫数目（枚）
观察组	31	153. 6±16. 1	130. 3±12. 2	13. 2±2. 5
对照组	30	159. 5±15. 8	135. 7±11. 9	12. 7±3. 1
χ ² 值		-1. 444	-1. 749	0. 695
P值		0. 154	0. 085	0. 490
组别	例数	消化道重建时间（min）	排气时间（d）	住院时间（d）
观察组	31	30. 6±2. 3	1. 4±0. 7	9. 2±0. 8
对照组	30	38. 9±4. 5	1. 5±0. 8	8. 9±1. 0
χ ² 值		-9. 024	-0. 520	1. 296
P值		0. 000	0. 605	0. 200

组别	例数	PH＜4反流次数（次）	PH＜4时间百分比（%）	最长反流时间（min）	反流持续时间＞5min次数（次）	Biox-Ochoa评分（分）
观察组	31	25. 1±2. 0	3. 1±0. 7	2. 2±0. 7	1. 3±0. 2	4. 1±0. 2
对照组	30	30. 6±3. 1	5. 2±1. 8	4. 3±1. 5	2. 2±0. 7	5. 9±1. 2
χ ² 值		-8. 261	-6. 042	-7. 044	-6. 876	-8. 237
P值		0. 000	0. 000	0. 000	0. 000	0. 000

组别	例数	反流性食管炎	吻合口漏	吻合口狭窄	切口出血	总并发症
观察组	31	0（0. 0）	0（0. 0）	0（0. 0）	1（3. 2）	1（3. 2）
对照组	30	3（10）	1（3. 3）	1（3. 3）	1（3. 3）	6（20. 0）
χ ²值		-	-	-	-	2. 733
P值		-	-	-	-	0. 098

References 15

［1］	Li S，Yuan L，Xu ZY，et al.Integrative proteomic characterization of adenocarcinoma of esophagogastric junction［J］.Nat Commun，2023，14（1）： 778.
［2］	邹庆涛，张洪贞，尹作文，等.食管胃结合部腺癌根治术三种消化道重建方式的临床效果评价［J/CD］.中华普外科手术学杂志（电子版），2022，16（05）： 545-548.
［3］	André T，Tougeron D，Piessen G，et al.Neoadjuvant Nivolumab Plus Ipilimumab and Adjuvant Nivolumab in Localized Deficient Mismatch Repair/Microsatellite Instability-High Gastric or Esophagogastric Junction Adenocarcinoma： The GERCOR NEONIPIGA Phase II Study［J］.J Clin Oncol，2023，41（2）： 255-265.
［4］	葛晗，张殿彩，徐泽宽.第6版日本《胃癌治疗指南》更新要点解读［J］.中国实用外科杂志，2022，42（01）： 35-40.
［5］	Wu CY，Ye K.Laparoscopic proximal gastrectomy with modified Kamikawa anastomosis： A video vignette［J］.Asian J Surg，2023，46（4）： 1714-1715.
［6］	中华医学会肿瘤学分会，中华医学会杂志社.中华医学会胃癌临床诊疗指南（2021版）［J］.中华医学杂志，2022，102（16）：1169-1189.
［7］	邹庆涛，张洪贞，尹作文，等.腹腔镜辅助全胃切除术与近端胃切除术治疗Siewert Ⅱ型食管胃结合部腺癌的近期及远期效果对比研究［J/CD］.中华普外科手术学杂志（电子版），2022，16（04）： 395-398.
［8］	Zhao JJ，Liu FL.Laparoscopic proximal gastrectomy and lymph node resection in adenocarcinoma of the esophagogastric junction［J］.Zhonghua Wei Chang Wai Ke Za Zhi，2022，25（2）：114-119.Chinese.
［9］	Fujii Y，Yasuda T，Inoue T.Laparoscopic Esophagogastric Anastomosis With Stapled Pseudo-Fornix for Reflux Esophagitis Prevention After Proximal Gastrectomy［J］.Cureus，2022，14（6）：e25561.
［10］	Kano Y，Ohashi M，Nunobe S.Laparoscopic Function-Preserving Gastrectomy for Proximal Gastric Cancer or Esophagogastric Junction Cancer： A Narrative Review［J］.Cancers （Basel），2023，15（1）： 311.
［11］	Aizawa M，Yabusaki H，Nakada K，et al.Simple modifications of conventional esophagogastrostomy after proximal gastrectomy adequately reduces the postoperative reflux esophagitis： a retrospective analysis of posterolateral fundoplication［J］.Langenbecks Arch Surg，2022，407（7）： 3153-3160.
［12］	Johari Y，Lim G，Wickremasinghe A，et al.Pathophysiological Mechanisms of Gastro-esophageal Reflux After Sleeve Gastrectomy［J］.Ann Surg，2022，276（5）： e407-e416.
［13］	Jung HK，Tae CH，Song KH，et al.Korean Society of Neurogastroenterology and Motility.2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease［J］.J Neurogastroenterol Motil，2021，27（4）： 453-481.
［14］	Ding S，Zheng X，Wang S，et al.Long-term nutritional status after total gastrectomy was comparable to proximal gastrectomy but with much less reflux esophagitis and anastomotic stenosis［J］.Front Oncol，2022，12： 973902.
［15］	Gong J，Liu X，Wang G，et al.Uncut interposed jejunum pouch versus esophago-gastrostomy and double anastomoses of jejunum to the esophagus and residual stomach： An innovative method of digestive tract reconstruction following proximal gastrectomy［J］.Asian J Surg，2023，46（10）： 4196-4201.

[1]	Xiaofeng Zhang, Junyong Ma, Xifeng Li, Lehua Shi, Feng Shen. Laparoscopic intrathecal anatomical right hemihepatectomy and regional lymph node dissection [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 245-245.
[2]	Haitao Sheng, Mingrui Dou, Junjie Wang, Xiaolong Xiu, Jianmao Yang, Changcheng Dong. Application of individualized hepatic segmentation based on CT three-dimensional visualization technology in anatomical hepatectomy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 258-261.
[3]	Zhixiang Wang, Zhanyang He. Clinical study of different lymph node dissections in locally advanced gastric cancer with limited metastasis of lymph node No.16 [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 266-269.
[4]	Changjun Shen, Wenqi Liu. Comparison of the application of different esophagojejunal reconstruction methods in esophagojejunostomy during transhiatal laparoscopic total gastrectomy （TLTG） for gastric cancer patients [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 270-273.
[5]	Feng Shen, Kui Wang, Jianwei Liu. The current status，challenges，and development of laparoscopic liver cancer surgery in China [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 237-240.
[6]	Chao Lu, Bo Chen, Zhixiang Xing, Peng Zhou, Shuai Wang. Clinical comparison of laparoscopic anatomical hepatectomy for hepatocellular carcinoma under different approaches [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(03): 254-257.
[7]	Jian Xiao, Tianbao Xiao, Jiang Chen, Tao Yang, Feng He, Tiantian Bao, Yibo Cao, Qin Yang, Ying Zhao. The value of indocyanine green imaging technique in radical resection of rectal cancer with left colonic artery preserved [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 134-137.
[8]	Fang Jin, Dongfei Xu, Peizhong Shang, Wei Zhang, Yanli Ge, Xiaoying Li, Jianjun Miao, Weilin Guo. Evaluation of the effect of selective application of ultrasonic knife and electric hook in laparoscopic Dixon surgery for rectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 142-145.
[9]	Lijun Zhou, Lu Wang, Qiao Lin. Comparison of the efficacy and complications of laparoscopic and open rectal resection for middle and low rectal cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 146-148.
[10]	Keke He, Haiyang Gu, Shu Xiao, Qi Wei, Xinyu Li. Clinical effect of laparoscopic ileocecal right hemicolectomy in the treatment of right hemicolon carcinoma [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 149-152.
[11]	Baohe Chen, Wenzhuo Zhang, Jun Wang. Clinical observation of proximal and medium-term laparoscopic radical resection of right half colon cancer by combined cephalocaudal approach [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 153-156.
[12]	Zhenzhen Li, Honggang Wang, Lili Cui, Yueqin Miu, Wanlu Liu. Safety and anti-reflux effect of modified tubular gastro-esophagostomy in laparoscopic proximal gastrectomy for gastrointestinal reconstruction [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 176-179.
[13]	Puliang Qi, Kaihua Sun, Junbang Ren, Lina Ma, Caixia Li, Qingshan Tian. Study on the application of minimally invasive gauze pad in the secondary operation of liver rupture in plateau area [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 196-199.
[14]	Linqiang Xue, Jungang Ge, Lin Gao, Leimin Qian, Jianming Huang. Application of modified SPLT esophagojejunostomy in laparoscopic total gastrectomy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 212-215.
[15]	Chuying Wu, Kai Ye. Laparoscopic surgical strategies for different sites of gastrointestinal stromal tumors [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(02): 224-227.

Please choose a citation manager

Content to export