Copyright
©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
Anti-reflux effects of a novel esophagogastric asymmetric anastomosis technique after laparoscopic proximal gastrectomy
Li-Qun Pang, Jie Zhang, Fang Shi, Cong Pang, Cheng-Wan Zhang, Ye-Liu Liu, Yao Zhao, Yan Qian, Xiang-Wei Li, Dan Kong, Shang-Nong Wu, Jing-Fang Zhou, Cong-Xue Xie, Song Chen
Li-Qun Pang, Jie Zhang, Ye-Liu Liu, Yao Zhao, Yan Qian, Xiang-Wei Li, Cong-Xue Xie, Department of General Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Fang Shi, Jiangsu Key Laboratory of Advanced Manufacturing Technology, Huaiyin Institute of Technology, Huaian 223300, Jiangsu Province, China
Cong Pang, Department of Neurosurgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Cheng-Wan Zhang, Department of Central Laboratory, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Dan Kong, Department of Imaging, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Shang-Nong Wu, Jing-Fang Zhou, Department of Gastroenterology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian 223300, Jiangsu Province, China
Song Chen, Institute of Medicinal Biotechnology, Jiangsu College of Nursing, Huaian 223300, Jiangsu Province, China
Author contributions: Pang LQ, Zhang J, Shi F, Pang C and Chen S conceived and designed the study; Pang LQ and Zhang J performed the operation; Zhang CW, Shi F, Pang C, Liu YL, Zhao Y, Qian Y, Li XW, Xie CX, Kong D, Wu SN, Zhou JF and Chen S contributed to the study design, analysis, and interpretation of the data; Pang LQ and Chen S wrote the manuscript; all authors reviewed and approved the manuscript; Pang LQ, Zhang J, Shi F, Pang C and Chen S contributed equally to this work.
Institutional review board statement: All experimental and surgical procedures of the study were approved by the ethics committee of The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University and strictly adhered to the guidelines of the Helsinki Declaration of 1964 and its latest amendments.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Li-Qun Pang, MD, PhD, Chief Physician, Surgeon, Surgical Oncologist, Department of General Surgery, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, No. 1 Huanghe West Road, Huaian 223300, Jiangsu Province, China. hayypanglq@njmu.edu.cn
Received: March 5, 2023
Peer-review started: March 5, 2023
First decision: April 13, 2023
Revised: May 2, 2023
Accepted: June 19, 2023
Article in press: June 19, 2023
Published online: August 27, 2023
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.
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.
