关键词: 胃体折叠术, 腹腔镜, 近端胃切除术, 抗反流手术, 食管胃吻合术

Abstract: The feasibility and anti-reflux effect of the esophagogastrostomy using overlap method combined with gastric remnant "U" shaped fold in total laparoscopic proximal gastrectomy for gastric cancer        WANG Jia, ZHANG Xiang-yu, ZHENG Yu, et al. Department of Gastrointestinal, Hernia and Abdominal Wall Surgery, the Second Hospital of Hebei Medical University, Shijiazhuang 050004, China
Corresponding author: ZHOU Bao-jun, E-mail:26700343@hebmu.edu.cn
Abstract  Objectives  To investigate the feasibility and evaluate the anti-reflux effect of the esophagogastrostomy using the overlap method combined with gastric remnant "U" shaped fold（EGOUF）in total laparoscopic proximal gastrectomy for gastric cancer. Methods    From February 2023 to December 2023, we retrospectively analyzed the clinical data of 16 patients with gastric cancer who underwent total laparoscopic proximal gastrectomy  in the Department of Gastrointestinal, Hernia and Abdominal Wall Surgery of the Second Hospital of Hebei Medical University. The EGOUF was used to reconstruct the digestive tract in all patients. The intraoperative and postoperative conditions of all patients were observed, and the patients were followed up for 3~12 months.  Results    All patients underwent resection of the tumor and digestive tract reconstruction under laparoscope. The time of operation and digestive tract reconstruction were（195.0±23.1）and （60.7±7.6）minutes, respectively. The intraoperative blood loss volume was 17.5 （10-50）ml, and the duration of postoperative stay in hospital was 9.5（8-13） days. No postoperative grade Ⅰ or above complication （Clavien Dindo） was observed. All patients were followed up for 3 months after the operation with a GerdQ scale score of 0, the patients did not complain of acid reflux, heartburn, abdominal pain, choking sensation during eating, and other symptoms. and no anastomotic stenosis or reflux was observed by the gastrointestinal angiography and gastroscopy. One patient （6.3%） was classified as LA-A（There was focal erythema on the mucosal side of the esophagus at the anastomosis）, and the other patients （93.8%） had no reflux esophagitis. 12 patients were followed up for 6 months after surgery, and the GerdQ score was 0. No discomfort such as acid reflux and heartburn was reported. The long-term nutritional indicators followed-up were normal. Four patients were followed up for 1 year, and no reflux esophagitis and complications occurred. None of the above patients had tumor recurrence. Conclusion    Laparoscopic digestive tract reconstruction with EGOUF is safe and feasible, with the smaller incision in the abdominal wall, which is conducive to patient recovery and has a good anti-reflux effect.

Key words: fundoplication, laparoscopy, proximal gastrectomy, anti-reflux surgery, esophagogastrostomy